Provider Demographics
NPI:1275105793
Name:HERRINGTON, MITCHELL S (RPH)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:S
Last Name:HERRINGTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E COFFEE ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-6141
Mailing Address - Country:US
Mailing Address - Phone:912-699-3784
Mailing Address - Fax:
Practice Address - Street 1:5 E COFFEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6141
Practice Address - Country:US
Practice Address - Phone:912-699-3784
Practice Address - Fax:912-699-8002
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist