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General NPI Number Information
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NPI Number | 1932087004
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Entity Type | Individual
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Provider Name | MITCHELL LEROY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 2800 PEARL ST
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City | BOULDER
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State | CO
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Zip | 80301-1123
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Country | US
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Telephone | 303-209-0102
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 9TH AVE APT 5203
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City | LONGMONT
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State | CO
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Zip | 80503-4076
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Country | US
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Telephone | 253-302-9801
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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 | PHA.0025335
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License Number State | CO
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