Provider Demographics
NPI:1750660643
Name:MITCHELL, ROBERT A (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10817 W HIGHWAY 71
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-9609
Mailing Address - Country:US
Mailing Address - Phone:512-288-3300
Mailing Address - Fax:512-288-3356
Practice Address - Street 1:10817 W HIGHWAY 71
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-9609
Practice Address - Country:US
Practice Address - Phone:512-288-3300
Practice Address - Fax:512-288-3356
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist