Provider Demographics
NPI:1164956645
Name:SANFORD CLINIC NORTH
Entity Type:Organization
Organization Name:SANFORD CLINIC NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:EISCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-333-5543
Mailing Address - Street 1:1233 34TH ST NW
Mailing Address - Street 2:SANFORD CLINIC PHARMACY
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5112
Mailing Address - Country:US
Mailing Address - Phone:218-333-5265
Mailing Address - Fax:218-333-5250
Practice Address - Street 1:1233 34TH ST NW
Practice Address - Street 2:SANFORD CLINIC PHARMACY
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5112
Practice Address - Country:US
Practice Address - Phone:218-333-5265
Practice Address - Fax:218-333-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN115828OtherMN BOARD OF PHARMACY LICENSE