Provider Demographics
NPI:1558630210
Name:KASSEKERT, VERNON ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:ANTHONY
Last Name:KASSEKERT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2149
Mailing Address - Country:US
Mailing Address - Phone:651-698-6502
Mailing Address - Fax:651-698-4834
Practice Address - Street 1:1585 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2149
Practice Address - Country:US
Practice Address - Phone:651-698-6502
Practice Address - Fax:651-698-4834
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist