Provider Demographics
NPI:1013929488
Name:MITCHELL, TINA MARIE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:65288 COUNTY ROAD 380
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-9420
Mailing Address - Country:US
Mailing Address - Phone:269-427-7706
Mailing Address - Fax:269-427-5752
Practice Address - Street 1:211 W MONROE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1330
Practice Address - Country:US
Practice Address - Phone:269-427-7706
Practice Address - Fax:269-427-5752
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician