Provider Demographics
NPI:1689002933
Name:DAWSON DRUG PLLC
Entity Type:Organization
Organization Name:DAWSON DRUG PLLC
Other - Org Name:DAWSON DRUG & GIFTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLESEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:320-769-2229
Mailing Address - Street 1:812 6TH ST.
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232
Mailing Address - Country:US
Mailing Address - Phone:320-769-2229
Mailing Address - Fax:320-312-6337
Practice Address - Street 1:812 6TH ST.
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232
Practice Address - Country:US
Practice Address - Phone:320-769-2229
Practice Address - Fax:320-312-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2642803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN264280OtherMN BOARD OF PHARMACY LICENSE
MN7072750001Medicare NSC