Provider Demographics
NPI:1841573037
Name:MITCHELL, KIMBERLY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 COUNTY ROAD 27
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-6994
Mailing Address - Country:US
Mailing Address - Phone:334-399-7422
Mailing Address - Fax:
Practice Address - Street 1:2451 COBBS FORD RD
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7763
Practice Address - Country:US
Practice Address - Phone:334-399-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist