Provider Demographics
NPI:1275284374
Name:INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:INTERNATIONAL FALLS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:RAINY LAKE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-283-5488
Mailing Address - Street 1:314 3RD ST
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2309
Mailing Address - Country:US
Mailing Address - Phone:218-283-3061
Mailing Address - Fax:218-520-3042
Practice Address - Street 1:314 3RD ST
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2309
Practice Address - Country:US
Practice Address - Phone:218-283-3061
Practice Address - Fax:218-520-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy