National Provider Identifier Database

LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.


Contact Information

LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
129 OLD ABE RD
LAC DU FLAMBEAU, WI54538
Phone: 715-588-3371
Fax: 715-588-2039
Website:
Specialty Taxonomy Code
* Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X

* Indicates primary specialty

NPI Profile & details for LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS

NPI Number 1447271408
Legal business name
LBN
LAC DU FLAMBEAU BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Authorized official RANDY SAMUELSON - (ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 07/22/2006
Last updated 02/27/2017 - About 9 years ago
Sole proprietor1 Not specified
Identifiers
  • WI License #: 8933-042
  • WI Medicaid: 32956800
  • Other: 5122382 NCPDP PROVIDER IDENTIFICATION NUMBER

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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