Healthcare Provider Details

I. General information

NPI: 1720163207
Provider Name (Legal Business Name): MILLE LACS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ELM ST N
ONAMIA MN
56359-7901
US

IV. Provider business mailing address

PO BOX A
ONAMIA MN
56359-0807
US

V. Phone/Fax

Practice location:
  • Phone: 320-532-2490
  • Fax: 320-532-2499
Mailing address:
  • Phone: 320-532-2490
  • Fax: 320-532-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number2010470
License Number StateMN

VIII. Authorized Official

Name: GREG STEFFENSON
Title or Position: PHARMACIST
Credential:
Phone: 320-532-2490