Active NPI
Mark C Anderson, RPH
- Pharmacist
- Hudson, WI
National Provider Identifier
1376635425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10955040
- Practice address
- 530 2ND St
Mickleson Drug Inc
Hudson, WI 54016 - Phone
- (715) 386-3344
- Fax
- (715) 386-5198
- NPI assigned
- Sep 28, 2006
- Last updated
- Mar 7, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10955040 | WI | Primary |
| Pharmacist | 183500000X | 1142750 | MN |
Addresses
Primary practice location
530 2ND St
Mickleson Drug Inc
Hudson, WI 54016
Mailing address
715 Lake Dr
Stillwater, MN 55082
Phone (651) 439-5295
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5106275 | Other | NAPB | |
| 33003000 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1142750 | MN | MD | Pharmacist |
| 10955040 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Micklesen Drug Inc | Current | Accepting new patients | |
| Micklesen Drug Inc | Pharmacist | Current | Accepting new patients |
Locations
530 2nd St
Hudson, WI 54016
Phone (715) 386-3344
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Pharmacist
- Hudson, WI
- NPI 1982781308
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1376635425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "715 LAKE DR",
"city": "STILLWATER",
"state": "MN",
"postal_code": "55082",
"telephone_number": "651-439-5295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 2ND ST",
"address_2": "MICKLESON DRUG INC",
"city": "HUDSON",
"state": "WI",
"postal_code": "54016",
"telephone_number": "715-386-3344",
"fax_number": "715-386-5198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "MARK",
"middle_name": "C",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "10955040",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "1142750",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NAPB",
"identifier": "5106275",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33003000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hudson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.