Provider Demographics
NPI:1386836856
Name:MOHR, MARK WILLIAM (PHARMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:MOHR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 LAKE ST S
Mailing Address - Street 2:
Mailing Address - City:LONG PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:56347-1545
Mailing Address - Country:US
Mailing Address - Phone:320-732-2915
Mailing Address - Fax:320-732-2107
Practice Address - Street 1:645 LAKE ST S
Practice Address - Street 2:
Practice Address - City:LONG PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:56347-1545
Practice Address - Country:US
Practice Address - Phone:320-732-2915
Practice Address - Fax:320-732-2107
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1179503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist