St Mary's Innovis Health

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

263266 Issued in MN

Legal business name

ST MARY'S INNOVIS HEALTH

Doing business as

Essentia Health Detroit Lakes Pharmacy

Practice address

211 Frazee Street East
Detroit Lakes, MN 56501

Phone

(218) 847-3537

Fax

(218) 847-4405

NPI assigned

Jul 5, 2006

Last updated

Jul 3, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

ESSENTIA HEALTHAs reported in NPPES

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

Authorized official

Name

Mr. Alan Hurley

Title

Coo

Phone

(701) 364-7667

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Essentia Health Detroit Lakes Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

St Marys Innovis Health2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• St Mary's Innovis Health

  dba Essentia Health Park Rapids Pharmacy

  • Community/Retail Pharmacy
  • Park Rapids, MN
  • NPI 1265378525
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Innovis Health LLC

  dba Essentia Health-North Fargo Clinic

  • Occupational Medicine Clinic/Center
  • Fargo, ND
  • NPI 1568918902

  Member Of

  NPD member

Locations

Practitioners 4

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.

• Adrienne Fiedler, PHARMD

  • Pharmacist
  • Detroit Lakes, MN
  • NPI 1558013078
  NPD (past)
• Sheila Ann Hensel, PHARM.D.

  • Ambulatory Care Pharmacist
  • Detroit Lakes, MN
  • NPI 1417609371
  NPD (past)
• Alyson Rose Larson, PHARMD

  • Pharmacist
  • Detroit Lakes, MN
  • NPI 1528344835
  NPD (past)
• Amy Marchus, PHARM D

  • Pharmacist
  • Detroit Lakes, MN
  • NPI 1346631629
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719964800000",
    "number": "1730110115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 FRAZEE STREET EAST",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "56501",
            "telephone_number": "218-847-3537",
            "fax_number": "218-847-4405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 FRAZEE STREET EAST",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "56501",
            "telephone_number": "218-847-3537",
            "fax_number": "218-847-4405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY'S INNOVIS HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "701-364-7667",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": "263266",
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "MN",
            "license": "263266",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "263266",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "2409995",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290678000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Detroit Lakes Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Detroit Lakes Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sherri L Softing, RD, LD
• Kelly J Soyring, OTR
• Bobi Lyn Spaeth
• Spectrum Health
• Dawn Spitzer
• St Mary's Regional Health Center (Essentia Health St Marys - Detroit Lakes (Swingbed))
• St Mary's Regional Health Center (Essentia Health- Lincoln Park)
• St Mary's Regional Health Center (Essentia Health St. Mary's - Detroit Lakes Clinic)
• St Marys EMS (Essentia Health EMS)
• St Marys Regional Health Center

• Community/Retail Pharmacy in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.