Provider Demographics
NPI:1134295967
Name:CAYLER, MITCHELL G (PHARMD, RPH)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:G
Last Name:CAYLER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 10TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1039
Mailing Address - Country:US
Mailing Address - Phone:218-631-4050
Mailing Address - Fax:218-631-2726
Practice Address - Street 1:321 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1372
Practice Address - Country:US
Practice Address - Phone:218-631-4050
Practice Address - Fax:218-631-2726
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116228-0183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116228-0OtherSTATE PHARMACIST LICENSE