Organization
GRAND ITASCA CLINIC AND HOSPITAL
Active
Parent organization
GRAND ITASCA CLINIC AND HOSPITAL
Other names
Grand Itasca Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRAND ITASCA CLINIC AND HOSPITAL
Authorized official
MRS. JEAN MACDONELL (CEO)
(218) 326-3401
Entity
Organization
Contact information
Practice address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 999-1702
Mailing address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 999-1885
(218) 999-1887
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288995200
—
MN
Enumeration date
06/09/2014
Last updated
03/24/2022
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