Healthcare Provider Details

I. General information

NPI: 1861435448
Provider Name (Legal Business Name): GARY LEE MITCHELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 H ST
FAIRBURY NE
68352-1119
US

IV. Provider business mailing address

922 8TH ST
FAIRBURY NE
68352-2430
US

V. Phone/Fax

Practice location:
  • Phone: 402-729-3354
  • Fax:
Mailing address:
  • Phone: 402-729-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8571
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: