=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396609707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINNESOTA AVE N PHARMACY SERVICES LIMITED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 226 MINNESOTA AVE N
-----------------------------------------------------
City | AITKIN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56431-1412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-670-7120
-----------------------------------------------------
Fax | 218-670-7120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 MINNESOTA AVE N
-----------------------------------------------------
City | AITKIN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56431-1412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-670-7120
-----------------------------------------------------
Fax | 218-670-7119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATTHEW DOUCETTE
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 218-546-5144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------