Organization
ST MARY'S INNOVIS HEALTH
Active
Parent organization
ESSENTIA HEALTH
Other names
Essentia Health Detroit Lakes Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
ESSENTIA HEALTH
Authorized official
MR. ALAN HURLEY (COO)
(701) 364-7667
Entity
Organization
Contact information
Practice address
211 FRAZEE STREET EAST, DETROIT LAKES, MN 56501
(218) 847-3537
(218) 847-4405
Mailing address
211 FRAZEE STREET EAST, DETROIT LAKES, MN 56501
(218) 847-3537
(218) 847-4405
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
263266
MN
3336C0002X
Clinic Pharmacy
263266
MN
3336C0003X
Community/Retail Pharmacy
Primary
263266
MN
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2409995
NABP NUMBER
MN
05
—
290678000
—
MN
Enumeration date
07/05/2006
Last updated
07/03/2024
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