Healthcare Provider Details

I. General information

NPI: 1841947801
Provider Name (Legal Business Name): MILLE LACS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ELM ST N
ONAMIA MN
56359-7901
US

IV. Provider business mailing address

200 ELM ST N
ONAMIA MN
56359-7901
US

V. Phone/Fax

Practice location:
  • Phone: 320-532-2492
  • Fax: 320-532-2499
Mailing address:
  • Phone: 320-532-2492
  • Fax: 320-532-2499

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: WILLIAM ROYCE NELSON
Title or Position: CEO
Credential:
Phone: 320-532-2580