Provider Demographics
NPI:1821891656
Name:SKAGGS, JO (RPH)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:SKAGGS
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1426
Mailing Address - Country:US
Mailing Address - Phone:573-713-4004
Mailing Address - Fax:573-713-4001
Practice Address - Street 1:516 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1426
Practice Address - Country:US
Practice Address - Phone:573-713-4004
Practice Address - Fax:573-713-4001
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPH044576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist