Provider Demographics
NPI:1114544822
Name:ROLSETH DRUG CO
Entity Type:Organization
Organization Name:ROLSETH DRUG CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:651-464-2114
Mailing Address - Street 1:26709 FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8022
Mailing Address - Country:US
Mailing Address - Phone:651-462-2082
Mailing Address - Fax:651-462-1089
Practice Address - Street 1:26709 FOREST BLVD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8022
Practice Address - Country:US
Practice Address - Phone:651-462-2082
Practice Address - Fax:651-462-1089
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROLSETH DRUG CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy