Provider Demographics
NPI:1780600759
Name:FIRSTSOLUTIONS
Entity type:Organization
Organization Name:FIRSTSOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CARE DELIVERY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTAW
Authorized Official - Suffix:
Authorized Official - Credentials:MT BA, ICP
Authorized Official - Phone:218-740-2785
Mailing Address - Street 1:1010 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1200
Mailing Address - Country:US
Mailing Address - Phone:218-834-7202
Mailing Address - Fax:218-834-9531
Practice Address - Street 1:1010 4TH ST
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1200
Practice Address - Country:US
Practice Address - Phone:218-834-7202
Practice Address - Fax:218-834-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336M0003X, 333600000X
MN2049333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2412966OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MN613226000Medicaid
MN613226000Medicaid