Provider Demographics
NPI:1922652270
Name:MITCHELL, MICHAEL LEE III (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:MITCHELL
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:LEE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:29 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2200
Mailing Address - Country:US
Mailing Address - Phone:504-232-8705
Mailing Address - Fax:
Practice Address - Street 1:7620 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1101
Practice Address - Country:US
Practice Address - Phone:225-929-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist