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General NPI Number Information
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NPI Number | 1861435448
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Entity Type | Individual
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Provider Name | GARY LEE MITCHELL PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2200 H ST
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City | FAIRBURY
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State | NE
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Zip | 68352-1119
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Country | US
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Telephone | 402-729-3354
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Fax |
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Provider Business Mailing Address
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Address Line | 922 8TH ST
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City | FAIRBURY
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State | NE
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Zip | 68352-2430
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Country | US
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Telephone | 402-729-3354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8571
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License Number State | NE
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