Provider Demographics
NPI:1821431008
Name:MIKKELSON, MARION KRISTA (RPH)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:KRISTA
Last Name:MIKKELSON
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 1:161 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-1607
Mailing Address - Country:US
Mailing Address - Phone:860-889-2487
Mailing Address - Fax:
Practice Address - Street 1:1657 ROUTE 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1533
Practice Address - Country:US
Practice Address - Phone:860-464-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist