| Organization Name: | FOND DU LAC RESERVATION BUSINESS COMMITTEE |
| NPI Number: | 1346501392 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHUCK ELLS (ASSOCIATE DIRECTOR) |
| Mailing Address: | 927 Trettel Ln Cloquet |
| State: | MN US |
| Postal Code: | 557201345 |
| Phone Number: | 2188791227 |
| Fax Number: | 2188782179 |
| NPI Enumeration Date: | 06/06/2012 |
| NPI Last Update Date: | 06/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0002X |
| License Number: | 260425 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Clinic Pharmacy |
| Taxonomy Definition: | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |