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General NPI Number Information
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NPI Number | 1447503941
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Entity Type | Organization
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Legal Business Name | MITCHELL'S MAIN STREET PHARMACY, INC
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 214 EAST MAIN ST
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560
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Country | US
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Telephone | 870-269-3253
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Fax | 870-269-5120
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Provider Business Mailing Address
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Address Line | PO BOX 2798
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-2798
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Country | US
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Telephone | 870-269-3253
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Fax | 870-269-5120
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDDIE MITCHELL
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Credential |
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Telephone | 870-269-3253
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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 | AR14641
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License Number State | AR
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