Provider Demographics
NPI:1083946487
Name:SKJOLDAL, LEAH DAWN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:DAWN
Last Name:SKJOLDAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1089
Mailing Address - Country:US
Mailing Address - Phone:732-687-9078
Mailing Address - Fax:
Practice Address - Street 1:747 PALMER AVE
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1089
Practice Address - Country:US
Practice Address - Phone:732-687-9078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054223183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy