Provider Demographics
NPI:1043211030
Name:MITCHELL, DELWIN EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DELWIN
Middle Name:EDWARD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 GRINSTEAD DR
Mailing Address - Street 2:APT 110
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2899
Mailing Address - Country:US
Mailing Address - Phone:502-580-2069
Mailing Address - Fax:502-508-2069
Practice Address - Street 1:2745 GRINSTEAD DR
Practice Address - Street 2:APT. 110
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2899
Practice Address - Country:US
Practice Address - Phone:502-580-2069
Practice Address - Fax:502-508-2069
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist