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General NPI Number Information
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NPI Number | 1154437564
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Entity Type | Organization
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Legal Business Name | THE DULUTH CLINIC, LTD
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 3500 TOWER AVE SUITE A
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City | SUPERIOR
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State | WI
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Zip | 54880-5335
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Country | US
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Telephone | 715-817-7880
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Fax | 715-395-3178
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Provider Business Mailing Address
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Address Line | 3500 TOWER AVE SUITE A
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City | SUPERIOR
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State | WI
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Zip | 54880-5335
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Country | US
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Telephone | 715-817-7880
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Fax | 715-395-3178
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | KEVIN BOREN
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Credential |
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Telephone | 218-786-1009
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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 | 7837
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License Number State | WI
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