MEDICARE: NANCY MITCHELL

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	30143	FL

General Provider Information

NPI Number	:	1346342813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY MITCHELL

Provider Business Mailing Address
First Line	:	2324 RAINTREE PL
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-4902
Country	:	US
Telephone Number	:	850-271-3234
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 S TYNDALL PKWY
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-6721
Country	:	US
Telephone Number	:	850-913-0076
Fax Number	:

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

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	07/08/2007

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Directions to “ NANCY MITCHELL ” Practice Location

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