Individual
MR. MARK DANIEL MOGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1015 13TH ST, MENOMINEE, MI 49858-2722
(906) 863-2589
Mailing address
1015 13TH ST, MENOMINEE, MI 49858-2722
(906) 863-2589
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
11976-040
WI
183500000X
Pharmacist
Primary
5302041718
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11976-040
WISCONSIN PHARMACIST LICENSE
WI
01
—
5302041718
MICHIGAN PHARMACIST LICENSE
MI
Enumeration date
02/01/2013
Last updated
04/24/2020
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