NPIMap

Organization Active NPI

Fond Du Lac Reservation Business Committee

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Cloquet, MN
National Provider Identifier
1346501392
Registry record updated Sep 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
260425 Issued in MN
Legal business name
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Practice address
927 Trettel LN
Cloquet, MN 55720-1345
Phone
(218) 879-1227
Fax
(218) 878-2179
NPI assigned
Jun 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2017

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

Authorized official

Name
Marilyn Grover
Title
Associate Director
Phone
(218) 879-1227

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 260425 MN Primary
Clinic Pharmacy 3336C0002X 260425 MN

Addresses

Primary practice location

927 Trettel LN
Cloquet, MN 55720-1345

Mailing address

927 Trettel LN
Cloquet, MN 55720-1345
Phone (218) 879-1227

Other names 1

  • MNAW Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
FDL Adolescent Outpatient TX8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505088000000",
    "number": "1346501392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LN",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201345",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-2179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LN",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201345",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-2179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC RESERVATION BUSINESS COMMITTEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2017-09-11",
        "status": "A",
        "authorized_official_last_name": "GROVER",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "218-879-1227"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "MN",
            "license": "260425",
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MN",
            "license": "260425",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MNAW Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cloquet, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2017; 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.