Provider Demographics
NPI:1760877831
Name:FARIS, MITCHELL LEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:LEE
Last Name:FARIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 LONSDALE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-4369
Mailing Address - Country:US
Mailing Address - Phone:661-428-7952
Mailing Address - Fax:
Practice Address - Street 1:6565 LONSDALE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-4369
Practice Address - Country:US
Practice Address - Phone:661-428-7952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-05
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist