Healthcare Provider Details

I. General information

NPI: 1306321773
Provider Name (Legal Business Name): PELICAN DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N BROADWAY
PELICAN RAPIDS MN
56572-4138
US

IV. Provider business mailing address

PO BOX 621
PELICAN RAPIDS MN
56572-0621
US

V. Phone/Fax

Practice location:
  • Phone: 218-863-1441
  • Fax:
Mailing address:
  • Phone: 218-863-1441
  • Fax: 218-863-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DONALD GUY PERRIN
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 218-863-1441