Healthcare Provider Details

I. General information

NPI: 1619903994
Provider Name (Legal Business Name): ROLSETH DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26710 FOREST BLVD
WYOMING MN
55092-8022
US

IV. Provider business mailing address

26710 FOREST BLVD PO BOX 584
WYOMING MN
55092-8022
US

V. Phone/Fax

Practice location:
  • Phone: 651-462-2082
  • Fax:
Mailing address:
  • Phone: 651-462-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2056641
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES E GARRISON
Title or Position: PRESIDENT
Credential:
Phone: 651-462-2082