Robert W Mickelson

NPI #1205135498 in Caldwell, Idaho

Provider Information

NPI Number: 1205135498
Entity Type: Individual
Name: Robert W Mickelson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Enumeration Date: Mar 28, 2011
Last Updated: Mar 28, 2011

Practice Location

Address: 2809 CLEVELAND BLVD
City: Caldwell
State: Idaho
ZIP Code: 83605-4443
Phone: (208) 455-1094

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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