Healthcare Provider Details

I. General information

NPI: 1245346659
Provider Name (Legal Business Name): THE DULUTH CLINIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KEENAN DR SUITE A
INTERNATIONAL FALLS MN
56649-2181
US

IV. Provider business mailing address

2501 KEENAN DR SUITE A
INTERNATIONAL FALLS MN
56649-2181
US

V. Phone/Fax

Practice location:
  • Phone: 218-285-6222
  • Fax: 218-285-6223
Mailing address:
  • Phone: 218-285-6222
  • Fax: 218-285-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2614177
License Number StateMN

VIII. Authorized Official

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