Robert W Mickelson

Primary specialty

PharmacistTaxonomy code 183500000X

License

P5300 Issued in ID

Practice address

2809 Cleveland Blvd
Caldwell, ID 83605-4443

Phone

(208) 455-1094

Fax

(208) 455-1097

NPI assigned

Mar 28, 2011

Last updated

Mar 28, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301270400000",
    "number": "1205135498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16122 HORIZON DR",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836078298",
            "telephone_number": "208-454-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 CLEVELAND BLVD",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054443",
            "telephone_number": "208-455-1094",
            "fax_number": "208-455-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "ROBERT",
        "middle_name": "W",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-28",
        "last_updated": "2011-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ID",
            "license": "P5300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Mendez, LMSW
• Devina Nadine Mendoza
• Micah S Mills OD PA (Treasure Valley Eyecare)
• Michael D Kenner, MD,PC
• Jacob Michelsen, PA
• Andrea Mikkelson, LPC
• Casey Jay Milburn
• Margaux Elena Miller
• Natasha Miller, MD
• Anastasia Brooke Milliron, NPC

• Pharmacist in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Pharmacist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.