Healthcare Provider Details

I. General information

NPI: 1376846402
Provider Name (Legal Business Name): TINA MARIE MITCHELL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2010
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 STAPLES MILL RD
HENRICO VA
23228-2021
US

IV. Provider business mailing address

9000 STAPLES MILL RD
HENRICO VA
23228-2021
US

V. Phone/Fax

Practice location:
  • Phone: 804-977-9515
  • Fax: 804-977-9517
Mailing address:
  • Phone: 804-977-9515
  • Fax: 804-977-9517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202204818
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: