Provider Demographics
NPI:1689947343
Name:MITCHELL, CARRIE LYNNE (RPH)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
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 1:2900 HAWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2000
Mailing Address - Country:US
Mailing Address - Phone:503-538-0691
Mailing Address - Fax:503-537-9179
Practice Address - Street 1:2900 HAWORTH AVE
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2000
Practice Address - Country:US
Practice Address - Phone:503-538-0691
Practice Address - Fax:503-537-9179
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7736OtherSTATE PHARMACIST LICENSE