Provider Demographics
NPI:1477872703
Name:MERITCARE WHEATON MEDICAL CENTER
Entity Type:Organization
Organization Name:MERITCARE WHEATON MEDICAL CENTER
Other - Org Name:MERITCARE WHEATON MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-234-4811
Mailing Address - Street 1:401 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MN
Mailing Address - Zip Code:56296-1070
Mailing Address - Country:US
Mailing Address - Phone:320-563-8226
Mailing Address - Fax:320-563-8012
Practice Address - Street 1:401 12TH ST N
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296-1070
Practice Address - Country:US
Practice Address - Phone:320-563-8226
Practice Address - Fax:320-563-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFM19862013336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy