MEDICARE: MRS. CARLA BRYANT MITCHELL RPH

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	PS29463	FL

General Provider Information

NPI Number	:	1215116256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLA BRYANT MITCHELL RPH

Provider Business Mailing Address
First Line	:	4356 NW 103RD AVE
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33351-8200
Country	:	US
Telephone Number	:	954-648-9416
Fax Number	:	954-578-2433

Provider Business Practice Location Address
First Line	:	2421 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6853
Country	:	US
Telephone Number	:	954-781-0778
Fax Number	:	954-946-6154

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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