Healthcare Provider Details

I. General information

NPI: 1114833886
Provider Name (Legal Business Name): MITCHEL DARVIN BODDEN II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 WILSON BLVD
ARLINGTON VA
22201-3856
US

IV. Provider business mailing address

309 HOLLAND LN UNIT 120
ALEXANDRIA VA
22314-6106
US

V. Phone/Fax

Practice location:
  • Phone: 571-895-7005
  • Fax:
Mailing address:
  • Phone: 504-994-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223230
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: