# MICKLESEN DRUG INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MICKLESEN DRUG
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033657283
- **Authorized official:** MARK ANDERSON (PHARMACIST)
- **Authorized official phone:** (715) 386-3344

## Contact information

- **Practice address:** 530 2ND ST, HUDSON, WI 54016-1799
- **Practice address phone:** (715) 386-3344
- **Practice address fax:** (715) 386-5198
- **Mailing address:** 530 2ND ST, HUDSON, WI 54016-1799
- **Mailing address phone:** (715) 386-3344
- **Mailing address fax:** (715) 386-5198

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 4862-42 | WI | Yes |

## Other

- **Enumeration date:** 02/08/2017
- **Last updated:** 09/19/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2167180 | PK | — |
| 05 | — | 33003000 | — | WI |