Individual
DR. MARK RYAN NICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
100 MONROE ST, ANOKA, MN 55303-2405
(763) 421-5540
Mailing address
10255 GREENBRIER RD APT 107, MINNETONKA, MN 55305-3425
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
120549
MN
Other
Enumeration date
08/09/2011
Last updated
08/09/2011
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