Provider Demographics
NPI:1508293259
Name:THE DULUTH CLINIC, LTD.
Entity Type:Organization
Organization Name:THE DULUTH CLINIC, LTD.
Other - Org Name:ESSENTIA HEALTH MEDICATION THERAPY MANAGEMENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:COORDINATOR PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MASTAW
Authorized Official - Suffix:
Authorized Official - Credentials:MT BA
Authorized Official - Phone:218-786-4265
Mailing Address - Street 1:1502 LONDON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1788
Mailing Address - Country:US
Mailing Address - Phone:218-576-0120
Mailing Address - Fax:218-733-1112
Practice Address - Street 1:1502 LONDON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1788
Practice Address - Country:US
Practice Address - Phone:218-576-0120
Practice Address - Fax:218-733-1112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. MARY'S DULUTH CLINIC HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site