Individual
MR. EDWIN M. MICKELSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
115 N 20TH AVE, CORNELIUS, OR 97113-7471
(503) 357-0762
(503) 357-0904
Mailing address
115 N 20TH AVE, CORNELIUS, OR 97113-7471
(503) 357-0762
(503) 357-0904
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0006856
OR
Other
Enumeration date
07/28/2010
Last updated
07/28/2010
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