Sara B Broten, PHARMD
Individual provider Active NPI Pharmacist · Roseau, MN
NPI 1811235013 · NPPES record last updated Jan 22, 2013
Key facts
- NPI
- 1811235013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 119836 (MN)
- Practice address
- 111 Main Ave S
Roseau, MN 56751-1421 - Phone
- (218) 463-2465
- Fax
- (218) 463-2875
- NPI assigned
- Jan 22, 2013
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119836 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mattson Pharmacy, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 119836 | MN | Yes |
Addresses
Primary practice location
111 Main Ave S
Roseau, MN 56751-1421
Mailing address
111 Main Ave S
Roseau, MN 56751-1421
Phone (218) 463-2465
Other providers in Roseau, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.