Healthcare Provider Details

I. General information

NPI: 1629353107
Provider Name (Legal Business Name): LAUREN MALOCH MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MAIN ST
STAMPS AR
71860-2827
US

IV. Provider business mailing address

795 COLUMBIA ROAD 258
MAGNOLIA AR
71753
US

V. Phone/Fax

Practice location:
  • Phone: 870-533-4311
  • Fax: 870-533-2731
Mailing address:
  • Phone: 870-696-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD11671
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: