Healthcare Provider Details

I. General information

NPI: 1487087961
Provider Name (Legal Business Name): LAURA ELISE MITCHELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16303 BRYANT RD
LAKE OSWEGO OR
97035-4307
US

IV. Provider business mailing address

600 NW 10TH AVE
PORTLAND OR
97209-3202
US

V. Phone/Fax

Practice location:
  • Phone: 503-636-5697
  • Fax:
Mailing address:
  • Phone: 503-227-4835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0013599
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: