Healthcare Provider Details

I. General information

NPI: 1972416659
Provider Name (Legal Business Name): JOHN MITCHELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

IV. Provider business mailing address

13601 KASBAUM LN
OKLAHOMA CITY OK
73150-8426
US

V. Phone/Fax

Practice location:
  • Phone: 800-349-7026
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17706
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: