Organization
MATHIESON ENTERPRISES INC
Active
Other names
BURCH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CALVIN MATHIESON (PRES OWNER)
(612) 871-1895
Entity
Organization
Contact information
Practice address
1942 HENNEPIN AVE, MINNEAPOLIS, MN 55403-3160
(612) 871-1895
(612) 871-1080
Mailing address
1942 HENNEPIN AVE, MINNEAPOLIS, MN 55403-3160
(612) 871-1895
(612) 871-1080
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2618270
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2403195
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
744418400
—
MN
Enumeration date
08/18/2006
Last updated
03/25/2010
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