Healthcare Provider Details

I. General information

NPI: 1992916720
Provider Name (Legal Business Name): SANDRA MITCHELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 SHERWOOD AVE
RICHMOND VA
23220-1210
US

IV. Provider business mailing address

703 BOULDER SPRINGS DR APT C1
RICHMOND VA
23225-5530
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-5618
  • Fax:
Mailing address:
  • Phone: 570-814-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207528
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP440998
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number0202207528
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: