Provider Demographics
NPI:1780391755
Name:SKLUZACEK, CHARLES ROBERT (PHARM D)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROBERT
Last Name:SKLUZACEK
Suffix:
Gender:M
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 1:1882 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MN
Mailing Address - Zip Code:55315-4592
Mailing Address - Country:US
Mailing Address - Phone:507-381-9937
Mailing Address - Fax:
Practice Address - Street 1:4050 DEAN LAKES BLVD
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2714
Practice Address - Country:US
Practice Address - Phone:952-402-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist