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Individual

MEGAN ROSE MICKELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
205 12TH ST S, SAUK CENTRE, MN 56378-1614
(320) 352-7943
Mailing address
205 12TH ST S, SAUK CENTRE, MN 56378-1614

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
122912
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
122912
MINNESOTA BOARD OF PHARMACY
MN
Enumeration date
09/10/2016
Last updated
09/10/2016
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