Provider Demographics
NPI:1548559420
Name:MITCHELL, CAMERON WAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:WAYNE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3380
Mailing Address - Country:US
Mailing Address - Phone:615-449-4653
Mailing Address - Fax:
Practice Address - Street 1:1418 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3380
Practice Address - Country:US
Practice Address - Phone:615-449-4653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist