Healthcare Provider Details

I. General information

NPI: 1679801823
Provider Name (Legal Business Name): THOMAS PATRICK MITCHELL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 BENT CREEK DR
SOUTHLAKE TX
76092-9410
US

IV. Provider business mailing address

4520 WESTERN CENTER BLVD
HALTOM CITY TX
76137-2635
US

V. Phone/Fax

Practice location:
  • Phone: 817-421-3421
  • Fax:
Mailing address:
  • Phone: 817-514-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32305
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: