Organization
WATERTOWN PHARMACY LLC
Active
Other names
Spring Park Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMARY ROSDAHL (CHIEF MANAGER)
(952) 955-2153
Entity
Organization
Contact information
Practice address
4689 SHORELINE DRIVE, SUITE 100, SPRING PARK, MN 55384
(952) 955-2153
(952) 471-1212
Mailing address
4689 SHORELINE DRIVE, SUITE 100, SPRING PARK, MN 55384
(952) 471-3784
(952) 471-1212
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164770756
—
MN
Enumeration date
08/29/2012
Last updated
06/08/2022
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