Healthcare Provider Details

I. General information

NPI: 1396609707
Provider Name (Legal Business Name): MINNESOTA AVE N PHARMACY SERVICES LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MINNESOTA AVE N
AITKIN MN
56431-1412
US

IV. Provider business mailing address

226 MINNESOTA AVE N
AITKIN MN
56431-1412
US

V. Phone/Fax

Practice location:
  • Phone: 218-670-7120
  • Fax: 218-670-7120
Mailing address:
  • Phone: 218-670-7120
  • Fax: 218-670-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DOUCETTE
Title or Position: OWNER
Credential: PHARM D
Phone: 218-546-5144