Organization
WATERTOWN PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSEMARY LOUISE ROSDAHL (OWNER)
(952) 955-2153
Entity
Organization
Contact information
Practice address
204 LEWIS AVE S STE 101, WATERTOWN, MN 55388-4501
(952) 955-2153
(952) 955-3067
Mailing address
204 LEWIS AVE S STE 101, WATERTOWN, MN 55388-4501
(952) 955-2153
(952) 955-3067
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
261954
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720013279
—
MN
01
—
3929710001
MEDICARE
—
Enumeration date
08/15/2018
Last updated
04/13/2022
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