Healthcare Provider Details

I. General information

NPI: 1073497665
Provider Name (Legal Business Name): KAITLYN ROSE SKOW PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 11TH ST NW STE 100
WADENA MN
56482-1044
US

IV. Provider business mailing address

421 11TH ST NW STE 100
WADENA MN
56482-1044
US

V. Phone/Fax

Practice location:
  • Phone: 218-632-2600
  • Fax: 218-631-8065
Mailing address:
  • Phone: 218-632-2600
  • Fax: 218-631-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number126622
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: