Healthcare Provider Details

I. General information

NPI: 1437457330
Provider Name (Legal Business Name): THE DULUTH CLINIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 EDISON BLVD SUITE L
SILVER BAY MN
55614-1211
US

IV. Provider business mailing address

99 EDISON BLVD SUITE L
SILVER BAY MN
55614-1211
US

V. Phone/Fax

Practice location:
  • Phone: 218-226-3829
  • Fax: 218-226-3860
Mailing address:
  • Phone: 218-226-3829
  • Fax: 218-226-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number263668
License Number StateMN

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: VP OF FINANCE
Credential:
Phone: 218-786-1009