Healthcare Provider Details

I. General information

NPI: 1396770830
Provider Name (Legal Business Name): ROSEMARY LOUISE ROSDAHL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LEWIS AVE S SUITE 101
WATERTOWN MN
55388-4500
US

IV. Provider business mailing address

204 LEWIS AVE S SUITE 101
WATERTOWN MN
55388-4500
US

V. Phone/Fax

Practice location:
  • Phone: 952-955-2153
  • Fax:
Mailing address:
  • Phone: 952-955-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113854
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: