Provider Demographics
NPI:1528595220
Name:MITCHELL, DEANNE (R PH)
Entity Type:Individual
Prefix:MS
First Name:DEANNE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 W CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9569
Mailing Address - Country:US
Mailing Address - Phone:720-630-1248
Mailing Address - Fax:
Practice Address - Street 1:THE APOTHECARY CU BOULDER
Practice Address - Street 2:CAMPUS BOX 119
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-0001
Practice Address - Country:US
Practice Address - Phone:303-492-8553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist