Provider Demographics
NPI:1851676977
Name:MIELKE, MEGAN LORRAINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LORRAINE
Last Name:MIELKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W MURDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2210
Mailing Address - Country:US
Mailing Address - Phone:920-231-8664
Mailing Address - Fax:920-231-8965
Practice Address - Street 1:315 W MURDOCK AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2210
Practice Address - Country:US
Practice Address - Phone:920-231-8664
Practice Address - Fax:920-231-8965
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15541-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist