Provider Demographics
NPI:1043982796
Name:SKOGSTAD, JESSE ALLAN I (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ALLAN
Last Name:SKOGSTAD
Suffix:I
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4389 TOWN ROAD 403 S
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-9125
Mailing Address - Country:US
Mailing Address - Phone:218-290-5627
Mailing Address - Fax:
Practice Address - Street 1:314 3RD ST
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2309
Practice Address - Country:US
Practice Address - Phone:218-283-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist