NPIMap

Organization Active NPI

Fond Du Lac Reservation Business Committee

Doing business as Fond Du Lac Cair Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Duluth, MN
National Provider Identifier
1629256763
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
260913 Issued in MN
Legal business name
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Doing business as
Fond Du Lac Cair Pharmacy
Practice address
221 W 4TH St
Duluth, MN 55806-2719
Phone
(218) 279-4142
Fax
(218) 279-4077
NPI assigned
Jan 31, 2008
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 260913 MN Primary

Addresses

Primary practice location

221 W 4TH St
Duluth, MN 55806-2719

Mailing address

Fond Du Lac Human Serv Division
927 Trettel Lane
Cloquet, MN 55720
Phone (218) 829-1227

Other identifiers 2

IdentifierTypeStateIssuer
2047381OtherPK
66815100MedicaidMN

Other names 1

  • FOND DU LAC CAIR 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": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1629256763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FOND DU LAC HUMAN SERV DIVISION",
            "address_2": "927 TRETTEL LANE",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-829-1227",
            "fax_number": "218-878-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 W 4TH ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558062719",
            "telephone_number": "218-279-4142",
            "fax_number": "218-279-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC RESERVATION BUSINESS COMMITTEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2022-07-21",
        "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": "260913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2047381",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66815100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOND DU LAC CAIR PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.