Provider Demographics
NPI:1437290921
Name:MITCHELL DRUG COMPANY INC
Entity Type:Organization
Organization Name:MITCHELL DRUG COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:931-484-5117
Mailing Address - Street 1:97 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4500
Mailing Address - Country:US
Mailing Address - Phone:931-484-5117
Mailing Address - Fax:931-456-2710
Practice Address - Street 1:97 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4500
Practice Address - Country:US
Practice Address - Phone:931-484-5117
Practice Address - Fax:931-456-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-02283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0647400001Medicare NSC