Provider Demographics
NPI:1437708492
Name:MITCHELL, KYLIE PATRICIA (RPH)
Entity Type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:PATRICIA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3987 MISSOURI FLAT ROAD STE 340
Mailing Address - Street 2:BOX 226
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5253
Mailing Address - Country:US
Mailing Address - Phone:530-409-5420
Mailing Address - Fax:
Practice Address - Street 1:8852 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9595
Practice Address - Country:US
Practice Address - Phone:707-838-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist