Provider Demographics
NPI:1295554293
Name:MITCHELL'S PARK STREET PHARMACY, INC.
Entity type:Organization
Organization Name:MITCHELL'S PARK STREET PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:870-297-8107
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:CALICO ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72519-0569
Mailing Address - Country:US
Mailing Address - Phone:870-297-8817
Mailing Address - Fax:
Practice Address - Street 1:526 PARK ST
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519-9070
Practice Address - Country:US
Practice Address - Phone:870-297-8107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy