Mattson Pharmacy, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

260108 Issued in MN

Legal business name

MATTSON PHARMACY, INC

Doing business as

Greenbush Pharmacy

Practice address

152 Main St N
Greenbush, MN 56726-4015

Phone

(218) 782-2366

Fax

(218) 782-2365

NPI assigned

Feb 15, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Linda Desrosier

Title

Manager

Phone

(218) 463-2465

Specialties & licenses 4

Addresses

Other identifiers 4

Other names 1

• Greenbush Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Mattson Pharmacy, Inc

  • Community/Retail Pharmacy
  • Roseau, MN
  • NPI 1346383908

  1850410127

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Mattson Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mattson Pharmacy, Inc

  • Community/Retail Pharmacy
  • Roseau, MN
  • NPI 1346383908
  NPD tax ID

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1386787729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39",
            "city": "GREENBUSH",
            "state": "MN",
            "postal_code": "567260039",
            "telephone_number": "218-782-2366",
            "fax_number": "218-782-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 MAIN ST N",
            "city": "GREENBUSH",
            "state": "MN",
            "postal_code": "567264015",
            "telephone_number": "218-782-2366",
            "fax_number": "218-782-2365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTSON PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2023-03-07",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "DESROSIER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "218-463-2465",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": "260108",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "260108",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": "260108",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MN",
            "license": "260108",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "2409604",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "2601083",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN TAX ID NUMBER",
            "identifier": "6319469",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "338257500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenbush Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Erin Christine Eeg, MOTR/L
• Independent School District 2683 (Greenbush - Middle River Schools)
• Lifecare Medical Center (Lifecare Clinic Greenbush)
• Lifecare Medical Center
• Martha J Lystad, NP
• Novacek Healthmart Pharmacy LLC (Novacek HealthMart Pharmacy)
• Karen Jean Novacek, R.PH
• Lisa M. Sang

• Community/Retail Pharmacy in Greenbush, MN
• Providers in Greenbush, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.