Micklesen Drug Inc

Primary specialty

PharmacistTaxonomy code 183500000X

License

4862042 Issued in WI

Legal business name

MICKLESEN DRUG INC

Practice address

530 Second St
Hudson, WI 54016

Phone

(715) 386-3344

Fax

(715) 386-5198

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mark C Anderson, RPH PHARMACIST IN CHNPI 1376635425

Title

President

Phone

(715) 386-3344

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

Tax ID family

Micklesen Drug2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Micklesen Drug Inc

  • Long Term Care Pharmacy
  • Hudson, WI
  • NPI 1033657283
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark C Anderson, RPH

  • Pharmacist
  • Hudson, WI
  • NPI 1376635425
  NPD Authorized official
• Bruce R. Anderson, PPH

  • Pharmacist
  • Hudson, WI
  • NPI 1255489522
  NPD (past)
• Richard Newberg, RPH

  • Pharmacist
  • Hudson, WI
  • NPI 1245322304
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1982781308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 SECOND ST",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "54016",
            "telephone_number": "715-386-3344",
            "fax_number": "715-386-5198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 SECOND ST",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "54016",
            "telephone_number": "715-386-3344",
            "fax_number": "715-386-5198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICKLESEN DRUG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-386-3344",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH PHARMACIST IN CH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "4862042",
            "primary": true
        }
    ],
    "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": []
}

• Christene Merrill
• Richard Merwin, PHARM.D.
• Peter Meyers
• Michael J Moller PA
• Micklesen Drug Inc
• Midwest Integrated Medical Center LLC
• Midwest Spinal Aid Centers, LLC
• William Patrick Milder, CRNA
• Julie Miller, RN
• Karley Miller

• Pharmacist in Hudson, WI
• Providers in Hudson, WI by specialty
• Pharmacist in Wisconsin

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.