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NPI Code Detail

MEDICARE: DEAN W MICKELSON RPH

MEDICARE: DEAN W MICKELSON RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist7878OR

General Provider Information

NPI Number : 1043464407
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEAN W MICKELSON RPH
Provider Business Mailing Address
First Line : 4048 NE HIGHWAY 101
Second Line :
City : LINCOLN CITY
State : OR
Zip : 97367-5069
Country : US
Telephone Number : 541-994-5670
Fax Number :
Provider Business Practice Location Address
First Line : 4048 NE HIGHWAY 101
Second Line :
City : LINCOLN CITY
State : OR
Zip : 97367-5069
Country : US
Telephone Number : 541-994-5670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2008
Last Update Date : 11/12/2008

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