Provider Demographics
NPI:1346627932
Name:HJELDEN, MICHAEL SHAE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAE
Last Name:HJELDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16173 STINEBURG DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-6724
Mailing Address - Country:US
Mailing Address - Phone:907-854-3083
Mailing Address - Fax:
Practice Address - Street 1:16173 STINEBURG DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-6724
Practice Address - Country:US
Practice Address - Phone:907-854-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-03
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician