Individual
MICHAEL J MICKSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1010 W RYAN ST, BRILLION, WI 54110-1079
(920) 756-2640
(920) 756-9262
Mailing address
6428 ARABIAN WAY, TWO RIVERS, WI 54241-8970
(920) 686-3740
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10271
WI
Other
Enumeration date
03/18/2013
Last updated
03/18/2013
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