Provider Demographics
NPI:1649277146
Name:ROTHHOLZ, MITCHEL CRAIG (RPH)
Entity type:Individual
Prefix:MR
First Name:MITCHEL
Middle Name:CRAIG
Last Name:ROTHHOLZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 GARDNER DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7732
Mailing Address - Country:US
Mailing Address - Phone:703-567-6171
Mailing Address - Fax:202-628-0443
Practice Address - Street 1:4922 GARDNER DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7732
Practice Address - Country:US
Practice Address - Phone:703-567-6171
Practice Address - Fax:202-628-0443
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21190OtherFL BD OF PHARMACY
VA0202011965OtherVA BD OF PHARMACY