Provider Demographics
NPI:1942582697
Name:MIELKE, KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MIELKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 US HIGHWAY 93 S
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5782
Mailing Address - Country:US
Mailing Address - Phone:406-755-5099
Mailing Address - Fax:406-756-3725
Practice Address - Street 1:2150 US HIGHWAY 93 S
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5782
Practice Address - Country:US
Practice Address - Phone:406-755-5099
Practice Address - Fax:406-756-3725
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist