Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Other names
MNAW Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN GROVER (ASSOCIATE DIRECTOR)
(218) 879-1227
Entity
Organization
Contact information
Practice address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
(218) 878-2179
Mailing address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
(218) 878-2179
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
260425
MN
3336C0002X
Clinic Pharmacy
260425
MN
Other
Enumeration date
06/06/2012
Last updated
09/11/2017
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