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Individual

ROBERT W MICKELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2809 CLEVELAND BLVD, CALDWELL, ID 83605-4443
(208) 455-1094
(208) 455-1097
Mailing address
16122 HORIZON DR, CALDWELL, ID 83607-8298
(208) 454-8890

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P5300
ID

Other

Enumeration date
03/28/2011
Last updated
03/28/2011
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