Provider Demographics
NPI:1699201541
Name:MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH
Entity Type:Organization
Organization Name:MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH
Other - Org Name:MAYO CLINIC PHARMACY CANNON FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:507-538-1680
Mailing Address - Street 1:PO BOX 083268
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60691-0268
Mailing Address - Country:US
Mailing Address - Phone:507-284-8451
Mailing Address - Fax:
Practice Address - Street 1:32021 COUNTY 24 BLVD
Practice Address - Street 2:SUITE 1716
Practice Address - City:CANNON FALLS
Practice Address - State:MN
Practice Address - Zip Code:55009-5003
Practice Address - Country:US
Practice Address - Phone:507-263-9825
Practice Address - Fax:507-263-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0297530014OtherMEDICARE
24-33542OtherNCPDP
MN265329OtherMN LICENSE
MN265329OtherMN LICENSE