Provider Demographics
NPI:1528393923
Name:MITCHELL, LORI JUNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JUNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 VILLAGE RD NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7417
Mailing Address - Country:US
Mailing Address - Phone:910-371-2692
Mailing Address - Fax:910-371-9028
Practice Address - Street 1:319 VILLAGE RD NE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7417
Practice Address - Country:US
Practice Address - Phone:910-371-2692
Practice Address - Fax:910-371-9028
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0105438Medicaid