Provider Demographics
NPI:1679896476
Name:MITCHELL, SAMANTHA ELAINE (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 MARCELL LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-3730
Mailing Address - Country:US
Mailing Address - Phone:704-234-0148
Mailing Address - Fax:
Practice Address - Street 1:5975 WEDDINGTON MONROE ROAD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-684-6036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist