Provider Demographics
NPI:1134451099
Name:MITCHELL, JACQUELYN PETERS (RPH)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:PETERS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6340
Mailing Address - Country:US
Mailing Address - Phone:315-724-3657
Mailing Address - Fax:
Practice Address - Street 1:8181 SENECA TPKE
Practice Address - Street 2:SUITE 2
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1100
Practice Address - Country:US
Practice Address - Phone:315-793-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist