Healthcare Provider Details

I. General information

NPI: 1124063730
Provider Name (Legal Business Name): JON ROGER SKAGGS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9300
US

IV. Provider business mailing address

3063 BOY SCOUT RD
ASHLAND KY
41102-6625
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax: 304-429-0273
Mailing address:
  • Phone: 304-429-6741
  • Fax: 304-429-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number007718
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number007718
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number0202004874
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number0202004874
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: