Provider Demographics
NPI:1093370694
Name:MINNESOTA AVE N PHARMACY SERVICES LIMITED
Entity Type:Organization
Organization Name:MINNESOTA AVE N PHARMACY SERVICES LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUCETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:218-851-6599
Mailing Address - Street 1:26653 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-2285
Mailing Address - Country:US
Mailing Address - Phone:218-851-6599
Mailing Address - Fax:218-670-7119
Practice Address - Street 1:226 MINNESOTA AVE N
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1412
Practice Address - Country:US
Practice Address - Phone:218-670-7120
Practice Address - Fax:218-670-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy