Individual
MR. MARK C ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
530 2ND ST, MICKLESON DRUG INC, HUDSON, WI 54016
(715) 386-3344
(715) 386-5198
Mailing address
715 LAKE DR, STILLWATER, MN 55082
(651) 439-5295
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10955040
WI
183500000X
Pharmacist
1142750
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33003000
—
WI
01
—
5106275
NAPB
—
Enumeration date
09/28/2006
Last updated
03/07/2023
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