Healthcare Provider Details

I. General information

NPI: 1265397749
Provider Name (Legal Business Name): SYLVIAN MANYI KAISER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 GRAND AVE
DULUTH MN
55807-2754
US

IV. Provider business mailing address

2128 W 3RD ST APT 1
DULUTH MN
55806-2060
US

V. Phone/Fax

Practice location:
  • Phone: 218-628-2897
  • Fax: 218-624-5853
Mailing address:
  • Phone: 218-628-2897
  • Fax: 218-624-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127189
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: