Individual
MEKENNA MARIE MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
707 S 8TH ST, COLORADO SPRINGS, CO 80905-1811
(719) 633-7511
Mailing address
3214 BARKERS FOREST LN, HOUSTON, TX 77084-5545
(832) 293-7377
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHA.0024948
CO
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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