Provider Demographics
NPI:1598369852
Name:MITCHELL, DOROTHY ANNE
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 CITY AVE S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-2905
Mailing Address - Country:US
Mailing Address - Phone:662-837-4100
Mailing Address - Fax:662-837-2888
Practice Address - Street 1:822 CITY AVE S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2905
Practice Address - Country:US
Practice Address - Phone:662-837-4100
Practice Address - Fax:663-837-2888
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD-07493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist