Provider Demographics
NPI:1558683607
Name:MISCHEL, MARY ELLEN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:MISCHEL
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 1:997 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-2689
Mailing Address - Country:US
Mailing Address - Phone:180-368-4335
Mailing Address - Fax:180-368-4123
Practice Address - Street 1:997 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-2689
Practice Address - Country:US
Practice Address - Phone:180-368-4335
Practice Address - Fax:180-368-4123
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12575183500000X
NC16997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist