Healthcare Provider Details

I. General information

NPI: 1558397232
Provider Name (Legal Business Name): CLEARWATER CNTY MEM HOSP PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 4TH ST NW
BAGLEY MN
56621-8305
US

IV. Provider business mailing address

203 4TH ST NW
BAGLEY MN
56621-8305
US

V. Phone/Fax

Practice location:
  • Phone: 218-694-6501
  • Fax: 218-694-2185
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2057721
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BARBARA BERGQUIST
Title or Position: PHARMASIST IN CHARGE
Credential: RPH
Phone: 218-694-6501