Individual
JUSTIN RYAN MIELKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
950 S KOELLER ST, OSHKOSH, WI 54902-6175
(920) 303-1712
Mailing address
950 KOELLER RD, OSHKOSH, WI 54902-6175
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15548-40
WI
Other
Enumeration date
11/19/2011
Last updated
11/19/2011
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