Provider Demographics
NPI:1750003653
Name:CUYUNA LAKES PHARMACY LLC
Entity type:Organization
Organization Name:CUYUNA LAKES PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-546-2300
Mailing Address - Street 1:320 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1645
Mailing Address - Country:US
Mailing Address - Phone:218-546-2345
Mailing Address - Fax:218-546-4330
Practice Address - Street 1:22418 STATE HWY 6
Practice Address - Street 2:SUITE 400
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1645
Practice Address - Country:US
Practice Address - Phone:218-545-5360
Practice Address - Fax:218-381-0020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUYUNA LAKES PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy