Active NPI
Charles Robert Skluzacek, PHARM D
- Pharmacist
- Shakopee, MN
National Provider Identifier
1780391755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 120685
- Practice address
- 4050 Dean Lakes Blvd
Shakopee, MN 55379-2714 - Phone
- (952) 402-9039
- NPI assigned
- Oct 31, 2022
- Last updated
- Oct 31, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 120685 | MN | Primary |
Addresses
Primary practice location
4050 Dean Lakes Blvd
Shakopee, MN 55379-2714
Mailing address
1882 Christy Dr
Carver, MN 55315-4592
Phone (507) 381-9937
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120685 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667174400000",
"number": "1780391755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1882 CHRISTY DR",
"city": "CARVER",
"state": "MN",
"postal_code": "553154592",
"telephone_number": "507-381-9937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4050 DEAN LAKES BLVD",
"city": "SHAKOPEE",
"state": "MN",
"postal_code": "553792714",
"telephone_number": "952-402-9039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKLUZACEK",
"first_name": "CHARLES",
"middle_name": "ROBERT",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-10-31",
"last_updated": "2022-10-31",
"certification_date": "2022-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "120685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shakopee, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.