Organization
WARROAD HERITAGE INC
Active
Other names
WARROAD HERITAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE ERICKSON RPH (OWNER MGR)
(218) 386-1088
Entity
Organization
Contact information
Practice address
321 LAKE ST NE, WARROAD, MN 56763-2305
(218) 386-1088
(218) 386-1780
Mailing address
PO BOX M, WARROAD, MN 56763-0640
(218) 386-1088
(218) 386-1780
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
200560
MN
3336L0003X
Long Term Care Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2412081
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
611760100
—
MN
Enumeration date
07/25/2006
Last updated
10/03/2011
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