Organization
THE DULUTH CLINIC, LTD
Active
Parent organization
ESSENTIA HEALTH
Other names
Essentia Health Lakeside Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
ESSENTIA HEALTH
Authorized official
KEVIN BOREN (VP OF FINANCE)
(218) 786-1009
Entity
Organization
Contact information
Practice address
4621 E SUPERIOR ST, SUITE A, DULUTH, MN 55804-2338
(218) 786-3784
(218) 525-7338
Mailing address
4621 E SUPERIOR ST, SUITE A, DULUTH, MN 55804-2338
(218) 786-3784
(218) 525-7338
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2612425
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106358800
—
MN
01
—
24-04642
NCPDP
MN
05
—
33163300
—
WI
01
—
573
THE DULUTH CLINIC, LTD CHAIN CODE
MN
Enumeration date
08/20/2006
Last updated
02/28/2024
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