Provider Demographics
NPI:1457386245
Name:FIRSTSOLUTIONS
Entity Type:Organization
Organization Name:FIRSTSOLUTIONS
Other - Org Name:SUPERIORHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-740-2330
Mailing Address - Street 1:1502 LONDON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1788
Mailing Address - Country:US
Mailing Address - Phone:218-733-1110
Mailing Address - Fax:218-733-1112
Practice Address - Street 1:1502 LONDON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1788
Practice Address - Country:US
Practice Address - Phone:218-733-1110
Practice Address - Fax:218-733-1112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRSTSOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261320-43336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN083323100Medicaid
MN0631490004Medicare NSC