Provider Demographics
NPI:1437691417
Name:VERMILION PHARMACY
Entity Type:Organization
Organization Name:VERMILION PHARMACY
Other - Org Name:BOIS FORTE RESERVATION TRIBAL GOVERNMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-757-3650
Mailing Address - Street 1:1613 FARM RD. SOUTH
Mailing Address - Street 2:
Mailing Address - City:TOWER
Mailing Address - State:MN
Mailing Address - Zip Code:55790
Mailing Address - Country:US
Mailing Address - Phone:218-753-2182
Mailing Address - Fax:
Practice Address - Street 1:1613 FARM RD. SOUTH
Practice Address - Street 2:
Practice Address - City:TOWER
Practice Address - State:MN
Practice Address - Zip Code:55790
Practice Address - Country:US
Practice Address - Phone:218-753-2182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service