Provider Demographics
NPI:1992009435
Name:MITCHELL, KENNETH B (NMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:NMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 N SCOTTSDALE RD STE 180
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5270
Mailing Address - Country:US
Mailing Address - Phone:602-441-3455
Mailing Address - Fax:602-682-7100
Practice Address - Street 1:11000 N SCOTTSDALE RD STE 180
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5270
Practice Address - Country:US
Practice Address - Phone:602-441-3455
Practice Address - Fax:602-682-7100
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-24
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7692183500000X
AZ10-1226175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No183500000XPharmacy Service ProvidersPharmacist