Mesaba Drug Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

200347 Issued in MN

Legal business name

MESABA DRUG INC

Doing business as

Mesaba Drug

Practice address

221 Kennedy Memorial Dr
Hoyt Lakes, MN 55750-1141

Phone

(218) 225-2128

Fax

(218) 225-3455

NPI assigned

Aug 10, 2006

Last updated

Sep 9, 2009By 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

Mary FossellNPI 1104392158

Title

President

Phone

(218) 225-2128

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• MESABA DRUG Doing business as

Locations

Practitioners 1

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.

• Mary Fossell, RPH

  • Pharmacist
  • Hoyt Lakes, MN
  • NPI 1104392158
  NPD (past) Authorized official

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252454400000",
    "number": "1538170048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 KENNEDY MEMORIAL DR",
            "city": "HOYT LAKES",
            "state": "MN",
            "postal_code": "557501141",
            "telephone_number": "218-225-2128",
            "fax_number": "218-225-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 KENNEDY MEMORIAL DR",
            "city": "HOYT LAKES",
            "state": "MN",
            "postal_code": "557501141",
            "telephone_number": "218-225-2128",
            "fax_number": "218-225-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESABA DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2009-09-09",
        "status": "A",
        "authorized_official_last_name": "FOSSELL",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-225-2128"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "200347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2405531",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "998058000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MESABA DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexis Jade Hammond
• Healing Center LLC
• Jeff Allen Homich
• Bryan Ann Johnson, LSW
• Darrell John Leier, M.D.
• Thrifty Drug Stores, Inc. (Thrifty White Pharmacy #792)
• Twin City Christian Homes Services Company (Avinity Home Care)

• Community/Retail Pharmacy in Hoyt Lakes, MN
• Providers in Hoyt Lakes, 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 Sep 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.