EAST OTTERTAIL PHARMACY (NPI# 1558473546) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558473546 |
| Entity Type | Organization |
| Organization Name | EAST OTTERTAIL PHARMACY |
| Other Organization Name | PERHAM HEALTH PHARMACY |
| Practice Address |
1000 Coney St W Perham MN 56573-2102 |
| Practice Telephone | 2183471570 |
| Practice Fax Number | 2183471574 |
| Mailing Telephone | 2183471570 |
| Mailing Fax Number | 2183471574 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-02-10 |
| Authorized Official Name | DUANE WALLACE (PHARMACY DIRECTOR) |
| Authorized Official Telephone | 2183471571 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
260379 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2046463 | 01 | |
| MN | 626258900 | 05 |
| Other Name | Type Code |
|---|---|
| PERHAM HEALTH PHARMACY | Doing Business As Name - Organization |
| Street Address |
1000 CONEY ST W |
| City | PERHAM |
| State | MN |
| Zip Code | 56573-2102 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982913505 | Illene T Reed | Family Medicine | 1000 Coney St W, Perham, MN 56573-2102 | 2006-05-05 |
| 1174001648 | Jodie Trites | Pharmacist | 1000 Coney St W, Perham, MN 56573-2102 | 2018-08-06 |
| 1649774670 | Colleen Ann Bauck | Registered Nurse | 1000 Coney St W, Perham, MN 56573-2102 | 2018-03-23 |
| 1770090094 | Amanda Carol Houghtaling | Nurse Practitioner | 1000 Coney St W, Perham, MN 56573-2102 | 2018-01-08 |
| 1467971572 | Rose Marie Mader | Registered Nurse | 1000 Coney St W, Perham, MN 56573-2102 | 2017-09-11 |
| 1134656994 | Matthew David Haugen | Family Medicine | 1000 Coney St W, Perham, MN 56573-2102 | 2017-05-11 |
| 1720521818 | Shannon Marie Guck | Physician Assistant | 1000 Coney St W, Perham, MN 56573-2102 | 2016-11-22 |
| 1962854646 | Rayna Bergseth | Nurse Practitioner | 1000 Coney St W, Perham, MN 56573-2102 | 2016-07-06 |
| 1821403635 | Kevin Dale Swenson | Physician Assistant | 1000 Coney St W, Perham, MN 56573-2102 | 2014-07-01 |
| 1972918472 | Melinda Kay Anderson | Nurse Practitioner | 1000 Coney St W, Perham, MN 56573-2102 | 2014-06-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558630012 | Perham Hospital District | Durable Medical Equipment & Medical Supplies | 1000 Coney Street West, Perham, MN 56573 | 2011-12-29 |
| 1730239385 | Dr. Kelvin K. Salathe, P.C. | Chiropractor | 101 West Coney St, Perham, MN 56573 | 2007-01-12 |
| 1124106299 | Langen Family Chiropractic, P.a. | Chiropractor | 108 Market Dr., Perham, MN 56573 | 2006-11-02 |
| 1285710335 | James Odin Langen | Chiropractor | 108 Market Drive, Perham, MN 56573 | 2006-10-31 |
| 1578572202 | Michael L Hamann | Dentist | 200 1st Ave S, Perham, MN 56573 | 2006-08-05 |
| 1033133517 | Timothy Charles Neitzke | Optometrist | 340 Fox St, Perham, MN 56573 | 2006-07-27 |
| 1023063757 | Shopko Stores Operating Co LLC | Pharmacy | 300 Jake St, Perham, MN 56573 | 2006-05-23 |
| 1164917233 | Katlin Larson | Behavior Technician | 735 3rd St Sw, Perham, MN 56573 | 2018-06-29 |
| 1104029347 | Tammy L Sturdevant | Dentist | 335 4th Ave, Perham, MN 56573 | 2007-06-06 |
| 1861610131 | Minnesota Eyecare Network Inc. | Eyewear Supplier (Equipment, not the service) | 340 Fox Street, Perham, MN 56573 | 2007-04-23 |
| Find all providers in zip 56573 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1205460169 | Genoa Healthcare, LLC | Pharmacy | 1515 Energy Park Dr Ste 110, Saint Paul, MN 55108-5229 | 2020-02-28 |
| 1801438361 | The Duluth Clinic, Ltd. | Pharmacy | 2 Division St Ste A, Deer River, MN 56636-8779 | 2019-10-16 |
| 1265084792 | Nudak Ventures, LLC | Pharmacy | 5418 Saint Croix Trl, North Branch, MN 55056-4203 | 2019-07-15 |
| 1659938116 | Sterlingrx Inc | Pharmacy | 1312 Northland Dr Ste 500, Mendota Heights, MN 55120-1436 | 2019-05-21 |
| 1639734346 | Seward Pharmacy LLC | Pharmacy | 2209 E Lake St, Minneapolis, MN 55407-4563 | 2019-05-08 |
| 1093370694 | Minnesota Ave N Pharmacy Services Limited | Pharmacy | 226 Minnesota Ave N, Aitkin, MN 56431-1412 | 2019-05-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.