Provider Demographics
NPI:1528204666
Name:MITCHELL, DEIDRE TOI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:TOI
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 1:1000 JOHNSON FERRY ROAD NORTHEAST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1611
Mailing Address - Country:US
Mailing Address - Phone:404-851-8902
Mailing Address - Fax:404-851-8682
Practice Address - Street 1:1000 JOHNSON FERRY ROAD NORTHEAST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1611
Practice Address - Country:US
Practice Address - Phone:404-851-8902
Practice Address - Fax:404-851-8682
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist