Healthcare Provider Details

I. General information

NPI: 1629416797
Provider Name (Legal Business Name): VIRGINIA D MITCHELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 E BROAD ST
COLUMBUS OH
43205-1546
US

IV. Provider business mailing address

2027 HYTHE RD
COLUMBUS OH
43220-4874
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-2833
  • Fax: 614-257-3140
Mailing address:
  • Phone: 740-707-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03129784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: