Organization
GRX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM MIKKELSEN (PHARMACIST)
(712) 830-4487
Entity
Organization
Contact information
Practice address
316 BROADWAY ST, AUDUBON, IA 50025-1104
(712) 563-2655
Mailing address
316 BROADWAY ST, AUDUBON, IA 50025-1104
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
22284
IA
Other
Enumeration date
07/16/2014
Last updated
07/16/2014
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