Healthcare Provider Details

I. General information

NPI: 1922024876
Provider Name (Legal Business Name): WHITE EARTH INDIAN HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40520 COUNTY HIGHWAY 34
OGEMA MN
56569-9612
US

IV. Provider business mailing address

40520 COUNTY HIGHWAY 34
OGEMA MN
56569-9612
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-6375
  • Fax: 218-983-6384
Mailing address:
  • Phone: 218-983-4300
  • Fax: 218-983-6384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LEEANN MARIE THORSON
Title or Position: DEPUTY CEO
Credential:
Phone: 218-983-6303