Provider Demographics
NPI:1609214758
Name:WILLGOHS, NATHANIEL B (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:B
Last Name:WILLGOHS
Suffix:
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 1:707 HIGHWAY 33 S
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2696
Mailing Address - Country:US
Mailing Address - Phone:218-879-6768
Mailing Address - Fax:218-879-5313
Practice Address - Street 1:707 HIGHWAY 33 S
Practice Address - Street 2:SUITE12
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2696
Practice Address - Country:US
Practice Address - Phone:218-879-6768
Practice Address - Fax:218-879-5313
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1159871835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy