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General NPI Number Information
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NPI Number | 1144566811
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Entity Type | Organization
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Legal Business Name | TIM MITCHELL MEDICAL INC
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 115 E HICKORY ST
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City | NEOSHO
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State | MO
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Zip | 64850-1806
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Country | US
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Telephone | 417-451-3776
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Fax | 417-451-2332
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Provider Business Mailing Address
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Address Line | 719 S NEOSHO BLVD
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City | NEOSHO
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State | MO
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Zip | 64850-2051
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Country | US
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Telephone | 417-451-3776
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Fax | 417-451-2332
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MR. TIM G MITCHELL
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Credential | RPH
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Telephone | 417-451-3776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 2012041816
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License Number State | MO
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