Organization
WARROAD HERITAGE INC
Active
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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