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General NPI Number Information
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NPI Number | 1073544151
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH SYSTEMS OF MOOSE LAKE INC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 204 LUNDORFF DR
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City | SANDSTONE
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State | MN
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Zip | 55072-5051
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Country | US
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Telephone | 320-245-5500
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Fax | 320-245-5123
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Provider Business Mailing Address
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Address Line | 710 S KENWOOD AVE
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City | MOOSE LAKE
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State | MN
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Zip | 55767
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Country | US
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Telephone | 218-485-5671
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. BILL STORCK
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Credential |
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Telephone | 218-485-5671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2614902
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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