Organization
EAST OTTERTAIL PHARMACY
Active
Other names
PERHAM HEALTH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DUANE WALLACE (PHARMACY DIRECTOR)
(218) 347-1571
Entity
Organization
Contact information
Practice address
1000 CONEY ST W, PERHAM, MN 56573-2102
(218) 347-1570
(218) 347-1574
Mailing address
1000 CONEY ST W, PERHAM, MN 56573-2102
(218) 347-1570
(218) 347-1574
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
260379
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2046463
PK
—
05
—
626258900
—
MN
Enumeration date
08/31/2006
Last updated
02/10/2016
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