Provider Demographics
NPI:1558645127
Name:MITCHELL, PAMELA K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:K
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 1:4560 PENNY LN SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-8324
Mailing Address - Country:US
Mailing Address - Phone:616-534-5175
Mailing Address - Fax:616-534-5452
Practice Address - Street 1:4560 PENNY LN SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-8324
Practice Address - Country:US
Practice Address - Phone:616-534-5175
Practice Address - Fax:616-534-5452
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302411212Other5302411212