Provider Demographics
NPI:1427333558
Name:SKALKO, GENE MAYNARD (RPH)
Entity type:Individual
Prefix:MR
First Name:GENE
Middle Name:MAYNARD
Last Name:SKALKO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17624 GERDINE PATH
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4474
Mailing Address - Country:US
Mailing Address - Phone:612-964-3180
Mailing Address - Fax:
Practice Address - Street 1:17624 GERDINE PATH
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4474
Practice Address - Country:US
Practice Address - Phone:612-964-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist