Organization
ROLSETH DRUG CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS R HAAS (MANAGER)
(651) 464-2114
Entity
Organization
Contact information
Practice address
107 LAKE ST N, FOREST LAKE, MN 55025-2504
(651) 464-2114
Mailing address
107 LAKE ST N, FOREST LAKE, MN 55025-2504
(651) 464-2114
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2003526
MN
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200760600
—
MN
Enumeration date
06/25/2006
Last updated
02/13/2020
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