Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Other names
FOND DU LAC CAIR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN GROVER (ASSOCIATE DIRECTOR)
(218) 879-1227
Entity
Organization
Contact information
Practice address
221 W 4TH ST, DULUTH, MN 55806-2719
(218) 279-4142
(218) 279-4077
Mailing address
FOND DU LAC HUMAN SERV DIVISION, 927 TRETTEL LANE, CLOQUET, MN 55720
(218) 829-1227
(218) 878-2188
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
260913
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2047381
PK
—
05
—
66815100
—
MN
Enumeration date
01/31/2008
Last updated
07/21/2022
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