1083726087 NPI number — ROSENAU INC

Table of content: (NPI 1083726087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083726087 NPI number — ROSENAU INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSENAU INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADA PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083726087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56510-0151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56510-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-784-4351
Provider Business Practice Location Address Fax Number:
218-784-3112
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENAU
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
218-784-4351

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  2608235 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1075608 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2419819 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com