Healthcare Provider Details

I. General information

NPI: 1114544822
Provider Name (Legal Business Name): ROLSETH DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26709 FOREST BLVD
WYOMING MN
55092-8022
US

IV. Provider business mailing address

26709 FOREST BLVD
WYOMING MN
55092-8022
US

V. Phone/Fax

Practice location:
  • Phone: 651-462-2082
  • Fax: 651-462-1089
Mailing address:
  • Phone: 651-462-2082
  • Fax: 651-462-1089

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: THOMAS HAAS
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 651-464-2114