North Shore Pharmacy LTD

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

NORTH SHORE PHARMACY LTD

Practice address

21 West Highway 61
Grand Marais, MN 55604

Phone

(218) 387-1133

Fax

(218) 387-2169

NPI assigned

Dec 19, 2006

Last updated

Mar 19, 2019By 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

Mr. Corey Todd Malstrom, PHARMDNPI 1205287745

Title

President

Phone

(612) 240-7571

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• Arrowhead Ventures Inc Former legal business name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Corey Todd Malstrom, PHARMD

  • Pharmacist
  • Grand Marais, MN
  • NPI 1205287745
  NPD (past) Authorized official
• Jill Kort, PHARMD

  • Pharmacist
  • Grand Marais, MN
  • NPI 1992181861
  NPD (past)

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1528121308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 SUMMIT ST STE 337",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55803",
            "telephone_number": "612-240-7571",
            "fax_number": "844-674-6737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 WEST HIGHWAY 61",
            "city": "GRAND MARAIS",
            "state": "MN",
            "postal_code": "55604",
            "telephone_number": "218-387-1133",
            "fax_number": "218-387-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE PHARMACY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "MALSTROM",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-240-7571",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MN",
            "license": "2602558",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "263022",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002432000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "460258700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arrowhead Ventures Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Arrowhead Ventures Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Brittny Marie Malec, CLD
• Corey Todd Malstrom, PHARMD
• Maggie McGowan-Stinski
• Jessi Elizabeth Nicholson, L.AC. MOM
• North Shore Health Therapies, Inc.
• Kelsey Saladin Oneil, DPT
• Patrick Wesley Pawlowski, DDS
• McCabe F Plaas, DC
• River of Life Rehab, LLC
• River of Life Rehab, LLC

• Pharmacy in Grand Marais, MN
• Providers in Grand Marais, MN by specialty
• Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; 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.