Provider Demographics
NPI:1376846402
Name:MITCHELL, TINA MARIE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:MARIE
Last Name:MITCHELL
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 1:7951 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1336
Mailing Address - Country:US
Mailing Address - Phone:804-266-5557
Mailing Address - Fax:804-261-1122
Practice Address - Street 1:7951 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1336
Practice Address - Country:US
Practice Address - Phone:804-266-5557
Practice Address - Fax:804-261-1122
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist