Provider Demographics
NPI:1073166674
Name:SANFORD HEALTH OF NORTHERN MINNESOTA
Entity Type:Organization
Organization Name:SANFORD HEALTH OF NORTHERN MINNESOTA
Other - Org Name:SANFORD BLACKDUCK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KUNKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-312-6549
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-8311
Practice Address - Street 1:81 1ST ST NW
Practice Address - Street 2:STE A
Practice Address - City:BLACKDUCK
Practice Address - State:MN
Practice Address - Zip Code:56630-0188
Practice Address - Country:US
Practice Address - Phone:218-835-7700
Practice Address - Fax:218-835-2030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANFORD HEALTH OF NORTHERN MINNESOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy