NPIMap

Organization Active NPI

Rolseth Drug Co

Doing business as Lindstrom Thrifty White Pharmacy

  • Pharmacist
  • Lindstrom, MN
National Provider Identifier
1336174853
Registry record updated Jul 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
2612852 Issued in MN
Legal business name
ROLSETH DRUG CO
Doing business as
Lindstrom Thrifty White Pharmacy
Practice address
30699 Lincoln Rd
Lindstrom, MN 55045-8083
Phone
(651) 257-4074
Fax
(651) 257-0919
NPI assigned
Jul 12, 2006
Last updated
Jul 1, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
ROLSETH DRUG COAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Matthew Garrison, PHARMDNPI 1285225789
Title
Pic
Phone
(651) 257-4074

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 2612852 MN Primary

Addresses

Primary practice location

30699 Lincoln Rd
Lindstrom, MN 55045-8083

Mailing address

30699 Lincoln Rd
Lindstrom, MN 55045
Phone (651) 257-4074

Other identifiers 1

IdentifierTypeStateIssuer
602514500MedicaidMN

Other names 1

  • Lindstrom Thrifty White Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930008011 MN DME Supplier - Pharmacy 1052438652 Practice locations: Lindstrom, MN
O20111024000780 MN Part B Supplier - Mass Immunization (Roster Biller Only) 1052438652 Practice locations: Lindstrom, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Rolseth Drug Co6 organizations share this tax ID, including this one
Part of
Rolseth Drug Co

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

26710 Forest Blvd
Wyoming, MN 55092
Phone (651) 462-2082

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1336174853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30699 LINCOLN RD",
            "city": "LINDSTROM",
            "state": "MN",
            "postal_code": "55045",
            "telephone_number": "651-257-4074",
            "fax_number": "651-257-0919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30699 LINCOLN RD",
            "city": "LINDSTROM",
            "state": "MN",
            "postal_code": "550458083",
            "telephone_number": "651-257-4074",
            "fax_number": "651-257-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROLSETH DRUG CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROLSETH DRUG CO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "GARRISON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "651-257-4074",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "2612852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602514500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lindstrom Thrifty White Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lindstrom, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.