Provider Demographics
NPI:1356679682
Name:SKIFSTAD, MOLLY ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:SKIFSTAD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-5109
Mailing Address - Country:US
Mailing Address - Phone:218-263-1044
Mailing Address - Fax:218-262-4322
Practice Address - Street 1:750 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2341
Practice Address - Country:US
Practice Address - Phone:218-362-6611
Practice Address - Fax:218-362-6698
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist