Organization
MATTSON PHARMACY, INC
Active
Other names
Greenbush Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA DESROSIER (MANAGER)
(218) 463-2465
Entity
Organization
Contact information
Practice address
152 MAIN ST N, GREENBUSH, MN 56726-4015
(218) 782-2366
(218) 782-2365
Mailing address
PO BOX 39, GREENBUSH, MN 56726-0039
(218) 782-2366
(218) 782-2365
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
260108
MN
3336C0003X
Community/Retail Pharmacy
Primary
260108
MN
3336C0004X
Compounding Pharmacy
260108
MN
3336L0003X
Long Term Care Pharmacy
260108
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2409604
NCPDP NUMBER
MN
01
—
2601083
PHARMACY LICENSE
MN
05
—
338257500
—
MN
01
—
6319469
MN TAX ID NUMBER
MN
Enumeration date
02/15/2007
Last updated
03/07/2023
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