MEDICARE: DR. JOSEY MITCHELL PHARMDD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	17757	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17757	OTHER	AL	ALBOP

General Provider Information

NPI Number	:	1164025102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEY MITCHELL PHARMDD

Provider Business Mailing Address
First Line	:	5685 BAYOU SAINT JOHN AVE
Second Line	:
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-4142
Country	:	US
Telephone Number	:	251-616-8377
Fax Number	:

Provider Business Practice Location Address
First Line	:	25761 PERDIDO BEACH BLVD
Second Line	:
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-6107
Country	:	US
Telephone Number	:	251-974-1590
Fax Number	:	251-974-1595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	04/09/2021

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