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General NPI Number Information
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NPI Number | 1144242330
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Entity Type | Organization
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Legal Business Name | MILLE LACS HEALTH SYSTEM
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 205 MAIN ST W
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City | ISLE
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State | MN
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Zip | 56342
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Country | US
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Telephone | 320-676-3115
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Fax | 320-676-3136
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Provider Business Mailing Address
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Address Line | PO BOX 2
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City | ISLE
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State | MN
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Zip | 56342-0002
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Country | US
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Telephone | 320-676-3115
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Fax | 320-676-3136
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Authorized Official
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Title or Position | HIM SUPERVISOR, CREDENTIALING
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Name | TANYA PELZER
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Credential |
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Telephone | 320-532-2361
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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 | 264269
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License Number State | MN
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