Healthcare Provider Details

I. General information

NPI: 1689342487
Provider Name (Legal Business Name): CASSIE DEGOEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSIE JOHNSON

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 09/06/2021
Certification Date: 09/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 GRAND AVE
DULUTH MN
55807-2754
US

IV. Provider business mailing address

2223 W 11TH ST
DULUTH MN
55806-1201
US

V. Phone/Fax

Practice location:
  • Phone: 218-628-2897
  • Fax:
Mailing address:
  • Phone: 920-252-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125346
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: