MEDICARE: ROSEMARY LOUISE ROSDAHL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	113854	MN

General Provider Information

NPI Number	:	1396770830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY LOUISE ROSDAHL RPH

Provider Business Mailing Address
First Line	:	204 LEWIS AVE S
Second Line	:	SUITE 101
City	:	WATERTOWN
State	:	MN
Zip	:	55388-4500
Country	:	US
Telephone Number	:	952-955-2153
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 LEWIS AVE S
Second Line	:	SUITE 101
City	:	WATERTOWN
State	:	MN
Zip	:	55388-4500
Country	:	US
Telephone Number	:	952-955-2153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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