Provider Demographics
NPI:1689342487
Name:DEGOEY, CASSIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:DEGOEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2223 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-1201
Mailing Address - Country:US
Mailing Address - Phone:920-252-2884
Mailing Address - Fax:
Practice Address - Street 1:4501 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2754
Practice Address - Country:US
Practice Address - Phone:218-628-2897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist