Provider Demographics
NPI:1326419375
Name:TROSPER, MITZI (PHARMD)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:
Last Name:TROSPER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14365 HIGHWAY 16 W
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:MS
Mailing Address - Zip Code:39328-7974
Mailing Address - Country:US
Mailing Address - Phone:769-486-1055
Mailing Address - Fax:769-486-1093
Practice Address - Street 1:14365 HIGHWAY 16 W
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:MS
Practice Address - Zip Code:39328-7974
Practice Address - Country:US
Practice Address - Phone:769-486-1055
Practice Address - Fax:769-486-1093
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist