Organization
MOUNTAIN LAKE PHARMACY LLC
Active
Other names
PETERSON DRUG AND GIFTS
Organization subpart
No
Provider details
NPI number
Authorized official
LORI WILLIS (ACQUISITIONS MANAGER)
(641) 366-3440
Entity
Organization
Contact information
Practice address
1007 3RD AVE, MOUNTAIN LAKE, MN 56159-1587
(507) 427-2707
(507) 427-2328
Mailing address
PO BOX 640, CONRAD, IA 50621-0640
(641) 366-3440
(641) 366-3442
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
260083
MN
3336L0003X
Long Term Care Pharmacy
—
—
Other
Enumeration date
11/10/2005
Last updated
01/17/2020
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