Provider Demographics
NPI:1891916706
Name:MITCHELL, MELISSA D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:D
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:177 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3966
Mailing Address - Country:US
Mailing Address - Phone:630-293-5360
Mailing Address - Fax:
Practice Address - Street 1:177 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3966
Practice Address - Country:US
Practice Address - Phone:630-293-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-291659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist