Healthcare Provider Details

I. General information

NPI: 1174096242
Provider Name (Legal Business Name): MARC ALAN MITCHELL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

584 CASTRO ST # 252
SAN FRANCISCO CA
94114-2512
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3785
  • Fax: 510-428-3094
Mailing address:
  • Phone: 415-939-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62303
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number62303
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number62303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: