Organization
MATTSON PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA M DESROSIER (MANAGER)
(218) 463-2465
Entity
Organization
Contact information
Practice address
111 MAIN AVE S, ROSEAU, MN 56751-1421
(218) 463-2465
(218) 463-2875
Mailing address
111 MAIN AVE S, ROSEAU, MN 56751-1421
(218) 463-2465
(218) 463-2875
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0683560001
MN
3336C0003X
Community/Retail Pharmacy
Primary
201190
MN
3336C0004X
Compounding Pharmacy
201190
MN
3336L0003X
Long Term Care Pharmacy
201190
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011903
PHARMACY LICENSE
MN
01
—
2407802
NCPDP NUMBER
MN
05
—
981858800
—
MN
Enumeration date
02/14/2007
Last updated
03/07/2023
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