Basic Information
| Provider Information | |||||||||
| NPI: | 1831109073 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ONALASKA PHARMACY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 860056 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554860056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087914156 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 191 THEATER RD | ||||||||
| Address2: | SUITE200 | ||||||||
| City: | ONALASKA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546508679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083925030 | ||||||||
| FaxNumber: | 6083925798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | BORTNEM | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7158385270 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 8677 | WI | Y | Suppliers | Pharmacy |
No ID Information.