Healthcare Provider Details

I. General information

NPI: 1134083744
Provider Name (Legal Business Name): ROLSETH DRUG CO
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

30699 LINCOLN RD
LINDSTROM MN
55045-8083
US

IV. Provider business mailing address

30699 LINCOLN RD
LINDSTROM MN
55045-8083
US

V. Phone/Fax

Practice location:
  • Phone: 651-257-4074
  • Fax: 651-257-0919
Mailing address:
  • Phone: 651-257-4074
  • Fax: 651-257-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HAAS III
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 651-307-5557