Organization
MILLE LACS BAND OF OJIBWE INDIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL ARCHIE MOOSE (COMMISSIONER OF HEALTH)
(320) 532-4750
Entity
Organization
Contact information
Practice address
43500 MIGIZI DRIVE, ONAMIA, MN 56359
(320) 532-4770
(320) 532-4705
Mailing address
43500 MIGIZI DRIVE, ONAMIA, MN 56359
(320) 532-4770
(320) 532-4705
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085753000
—
MN
Enumeration date
03/21/2007
Last updated
03/07/2023
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