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General NPI Number Information
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NPI Number | 1346383908
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Entity Type | Organization
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Legal Business Name | MATTSON PHARMACY, INC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 111 MAIN AVE S
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City | ROSEAU
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State | MN
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Zip | 56751-1421
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Country | US
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Telephone | 218-463-2465
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Fax | 218-463-2875
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Provider Business Mailing Address
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Address Line | 111 MAIN AVE S
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City | ROSEAU
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State | MN
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Zip | 56751-1421
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Country | US
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Telephone | 218-463-2465
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Fax | 218-463-2875
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LINDA M DESROSIER
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Credential |
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Telephone | 218-463-2465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 201190
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 201190
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0683560001
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 201190
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License Number State | MN
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