Provider Demographics
NPI:1982581252
Name:MARSDEN, MATTHEW GERARD
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GERARD
Last Name:MARSDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1524
Mailing Address - Country:US
Mailing Address - Phone:612-709-0903
Mailing Address - Fax:
Practice Address - Street 1:1714 CENTER AVE W
Practice Address - Street 2:
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529-1330
Practice Address - Country:US
Practice Address - Phone:218-287-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN127041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist