Provider Demographics
NPI:1750664744
Name:CONCEPCION MITCHELL, LUCY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:
Last Name:CONCEPCION MITCHELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:LUCITA
Other - Middle Name:CONCEPCION
Other - Last Name:BALMEDIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2419 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2402
Mailing Address - Country:US
Mailing Address - Phone:415-759-1595
Mailing Address - Fax:
Practice Address - Street 1:830 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3302
Practice Address - Country:US
Practice Address - Phone:415-455-9919
Practice Address - Fax:415-455-4532
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 32803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 33803OtherBOARD OF PHARMACY