Provider Demographics
NPI:1003832064
Name:MITCHELL, GAYLA S (PHARMACH TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARMACH TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CLINIC PHARMACY
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2136
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:4241 HWY 14 W
Practice Address - Street 2:REA CLINIC PHARMACY
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822
Practice Address - Country:US
Practice Address - Phone:618-724-2136
Practice Address - Fax:618-724-2571
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician