Provider Demographics
NPI:1710030978
Name:SKELTON DRUG INC
Entity Type:Organization
Organization Name:SKELTON DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:651-674-4454
Mailing Address - Street 1:6344 MAIN ST
Mailing Address - Street 2:P.O. BOX 386
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6693
Mailing Address - Country:US
Mailing Address - Phone:651-674-4454
Mailing Address - Fax:651-674-2082
Practice Address - Street 1:6344 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6693
Practice Address - Country:US
Practice Address - Phone:651-674-4454
Practice Address - Fax:651-674-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0594580001Medicare ID - Type Unspecified