Provider Demographics
NPI:1023417714
Name:WEBSTER, MITCHELL (PHARMD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 AURORA AVE UNIT 411
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6291
Mailing Address - Country:US
Mailing Address - Phone:715-928-0072
Mailing Address - Fax:
Practice Address - Street 1:2555 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2051
Practice Address - Country:US
Practice Address - Phone:815-787-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist