MEDICARE: WHITNEY ELEECE MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302041112	MI

General Provider Information

NPI Number	:	1588296727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY ELEECE MITCHELL

Provider Business Mailing Address
First Line	:	3530 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-1944
Country	:	US
Telephone Number	:	810-987-7333
Fax Number	:	810-987-2426

Provider Business Practice Location Address
First Line	:	3530 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-1944
Country	:	US
Telephone Number	:	810-987-7333
Fax Number	:	810-987-2426

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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Directions to “ WHITNEY ELEECE MITCHELL ” Practice Location

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