Provider Demographics
NPI:1457419269
Name:ANLIKER, MARK M (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:M
Last Name:ANLIKER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:50536-2515
Mailing Address - Country:US
Mailing Address - Phone:712-852-2727
Mailing Address - Fax:712-852-2975
Practice Address - Street 1:3204 1ST ST
Practice Address - Street 2:
Practice Address - City:EMMETSBURG
Practice Address - State:IA
Practice Address - Zip Code:50536-2515
Practice Address - Country:US
Practice Address - Phone:712-852-2727
Practice Address - Fax:712-852-2975
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15692OtherPHARMACIST LICENSE