Healthcare Provider Details

I. General information

NPI: 1801438361
Provider Name (Legal Business Name): THE DULUTH CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DIVISION ST STE A
DEER RIVER MN
56636-8779
US

IV. Provider business mailing address

PO BOX 38
DEER RIVER MN
56636-0038
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-8642
  • Fax:
Mailing address:
  • Phone: 218-246-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: VP OF FINANCE
Credential:
Phone: 218-786-1009