Provider Demographics
NPI:1134721905
Name:TUTTLE, MITCHELL L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:TUTTLE
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 1:1509 RADIUM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-4021
Mailing Address - Country:US
Mailing Address - Phone:229-439-2248
Mailing Address - Fax:229-432-2311
Practice Address - Street 1:30 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1588
Practice Address - Country:US
Practice Address - Phone:912-634-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty