Provider Demographics
NPI:1861011934
Name:BRONK, MIA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MIA
Middle Name:MARIE
Last Name:BRONK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-7121
Mailing Address - Country:US
Mailing Address - Phone:515-890-0749
Mailing Address - Fax:
Practice Address - Street 1:1500 HIGHWAY 169 N
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-1019
Practice Address - Country:US
Practice Address - Phone:515-295-9237
Practice Address - Fax:515-295-9214
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist