Cass Lake Indian Hospital Pharmacy

Primary specialty

Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X

License

2603942 Issued in MN

Legal business name

CASS LAKE INDIAN HOSPITAL PHARMACY

Doing business as

Cass Lake Indian Hospital Pharmacy

Practice address

425 7TH St NW
Cass Lake, MN 56633-3360

Phone

(218) 335-3313

Fax

(218) 335-3352

NPI assigned

Feb 27, 2007

Last updated

Oct 23, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kailee Fretland, PHARMD

Title

Principal Pharmacy Consultant

Phone

(240) 478-2245

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• CASS LAKE INDIAN HOSPITAL PHARMACY Doing business as

Tax ID family

Department of Health Human3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Department of Human Services & PHS, IHS

  • Durable Medical Equipment & Medical Supplies
  • Cass Lake, MN
  • NPI 1659404051
  NPD tax ID
• Department of Human Services &PHS, IHS

  • Federal Public Health Clinic/Center
  • Cass Lake, MN
  • NPI 1144353343
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1053447599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95421",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441010033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 7TH ST NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333360",
            "telephone_number": "218-335-3313",
            "fax_number": "218-335-3352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASS LAKE INDIAN HOSPITAL PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A",
        "authorized_official_last_name": "FRETLAND",
        "authorized_official_first_name": "KAILEE",
        "authorized_official_title_or_position": "PRINCIPAL PHARMACY CONSULTANT",
        "authorized_official_telephone_number": "240-478-2245",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "MN",
            "license": "2603942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2046504",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "966553600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CASS LAKE INDIAN HOSPITAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CASS LAKE INDIAN HOSPITAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Buckanaga, RN
• Dwayne Caneen, RN
• Aaron Carter
• Terri Lynn Carter
• Cass Lake Indian Hospital
• Cass Lake-Bena Isd #115
• Caitlin Cavanaugh, DPT
• Stacy Ann Cederstrom, FNP
• Linda Conner, RN
• Joseph Cook Jr.

• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Cass Lake, MN
• Providers in Cass Lake, MN by specialty
• Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.