Healthcare Provider Details

I. General information

NPI: 1942816939
Provider Name (Legal Business Name): THE DULUTH CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 BELKNAP ST STE 100
SUPERIOR WI
54880-2905
US

IV. Provider business mailing address

204 BELKNAP ST STE 100
SUPERIOR WI
54880-2905
US

V. Phone/Fax

Practice location:
  • Phone: 218-817-7224
  • Fax: 218-817-7144
Mailing address:
  • Phone: 715-817-7224
  • Fax: 218-817-7144

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