Provider Demographics
NPI:1720372162
Name:MITCHELL, AMY JANINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JANINE
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 1:1865 N NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5194
Mailing Address - Country:US
Mailing Address - Phone:812-376-6938
Mailing Address - Fax:812-376-6938
Practice Address - Street 1:1865 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5194
Practice Address - Country:US
Practice Address - Phone:812-376-6938
Practice Address - Fax:812-376-6938
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015360A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist