Provider Demographics
NPI:1023790458
Name:MITCHELL, COLIN KHAYREE (PHARMD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:KHAYREE
Last Name:MITCHELL
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 1:1912 FAIRWAY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5559
Mailing Address - Country:US
Mailing Address - Phone:214-425-8612
Mailing Address - Fax:
Practice Address - Street 1:1912 FAIRWAY GLEN DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5559
Practice Address - Country:US
Practice Address - Phone:214-425-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist