Healthcare Provider Details

I. General information

NPI: 1619412624
Provider Name (Legal Business Name): LESLIE MITCHELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

41 MALL RD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-3401
  • Fax: 781-744-5446
Mailing address:
  • Phone: 781-744-3401
  • Fax: 781-744-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH20807
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: