Healthcare Provider Details

I. General information

NPI: 1073544151
Provider Name (Legal Business Name): FAMILY HEALTH SYSTEMS OF MOOSE LAKE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LUNDORFF DR
SANDSTONE MN
55072-5051
US

IV. Provider business mailing address

710 S KENWOOD AVE
MOOSE LAKE MN
55767
US

V. Phone/Fax

Practice location:
  • Phone: 320-245-5500
  • Fax: 320-245-5123
Mailing address:
  • Phone: 218-485-5671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2614902
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. BILL STORCK
Title or Position: COO
Credential:
Phone: 218-485-5671