Healthcare Provider Details

I. General information

NPI: 1386522530
Provider Name (Legal Business Name): MITCHELLE CAUSIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 E BASELINE RD
PHOENIX AZ
85042-6910
US

IV. Provider business mailing address

2140 E BASELINE RD
PHOENIX AZ
85042-6910
US

V. Phone/Fax

Practice location:
  • Phone: 602-281-1120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS027593
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: