Healthcare Provider Details

I. General information

NPI: 1750169645
Provider Name (Legal Business Name): MELISSA CLASSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 14TH ST
DULUTH MN
55811-2704
US

IV. Provider business mailing address

221 E 14TH ST
DULUTH MN
55811-2704
US

V. Phone/Fax

Practice location:
  • Phone: 218-740-2650
  • Fax:
Mailing address:
  • Phone: 218-740-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number125232
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21242-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: