Healthcare Provider Details

I. General information

NPI: 1881380616
Provider Name (Legal Business Name): MITCHELL'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12137 HWY 4
CHATHAM CA
71226
US

IV. Provider business mailing address

12137 HWY 4
CHATHAM CA
71226
US

V. Phone/Fax

Practice location:
  • Phone: 318-259-7466
  • Fax: 318-259-8019
Mailing address:
  • Phone: 318-259-7466
  • Fax: 318-259-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DWAYNE RICHARD MITCHELL
Title or Position: PHARMACIST/OWNER
Credential: RPH
Phone: 318-259-7466