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General NPI Number Information
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NPI Number | 1386759496
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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 | 08/20/2006
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 11134 N STATE ROAD 77 STE A
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City | HAYWARD
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State | WI
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Zip | 54843-5325
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Country | US
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Telephone | 715-634-6774
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Fax | 715-634-5517
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Provider Business Mailing Address
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Address Line | 11134 N STATE ROAD 77 STE A
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City | HAYWARD
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State | WI
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Zip | 54843-5325
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Country | US
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Telephone | 715-634-6774
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Fax | 715-634-5517
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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 | 7772
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License Number State | WI
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