Healthcare Provider Details

I. General information

NPI: 1932327152
Provider Name (Legal Business Name): CUYUNA LAKES PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E MAIN ST
CROSBY MN
56441-1645
US

IV. Provider business mailing address

320 E MAIN ST
CROSBY MN
56441-1645
US

V. Phone/Fax

Practice location:
  • Phone: 218-546-2345
  • Fax: 218-546-4330
Mailing address:
  • Phone: 218-546-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number2620093
License Number StateMN

VIII. Authorized Official

Name: DR. ELISE N DURGIN
Title or Position: DIRECTOR
Credential: PHARMD
Phone: 218-546-2345