Provider Demographics
NPI:1275563231
Name:MITCHELL, JAMES COLEMAN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:COLEMAN
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2315 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4509
Mailing Address - Country:US
Mailing Address - Phone:757-586-5552
Mailing Address - Fax:757-586-5558
Practice Address - Street 1:2315 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4509
Practice Address - Country:US
Practice Address - Phone:757-586-5552
Practice Address - Fax:757-856-5558
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008514305Medicaid
VA009123610Medicaid
VA0240010001Medicare NSC