Provider Demographics
NPI:1255467551
Name:MITCHELL, DENNIS EVERETT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:EVERETT
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60023 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-8985
Mailing Address - Country:US
Mailing Address - Phone:662-256-2680
Mailing Address - Fax:662-257-1207
Practice Address - Street 1:702 EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-9403
Practice Address - Country:US
Practice Address - Phone:662-257-1212
Practice Address - Fax:662-257-1207
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01109717Medicaid
MS01109717Medicaid