Provider Demographics
NPI:1205505484
Name:MITCHELL, SCOTT MICHAEL
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHAEL
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SHEFFIELD HILL RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-2907
Mailing Address - Country:US
Mailing Address - Phone:401-284-8016
Mailing Address - Fax:
Practice Address - Street 1:4255 QUAKER LN
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3654
Practice Address - Country:US
Practice Address - Phone:401-372-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPH109508183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician