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Contact Information

WATERTOWN PHARMACY LLC
4689 SHORELINE DRIVE
SUITE 100
SPRING PARK, MN55384
 Phone: 952-955-2153
 Fax: 952-471-1212
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Compounding Pharmacy

3336C0004X 58 Medical Supply Company with Pharmacist
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for WATERTOWN PHARMACY LLC

NPI Number 1164770756
LBN Legal business name WATERTOWN PHARMACY LLC
Authorized official ROSEMARY ROSDAHL - (CHIEF MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/29/2012
Last updated 06/08/2022 - About 4 years ago
Identifiers
MN Medicaid 1164770756
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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