Provider Demographics
NPI:1649864059
Name:MITCHELL, AMMON NIELS LANDON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMMON
Middle Name:NIELS LANDON
Last Name:MITCHELL
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 1:24417 BROTHERS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-5083
Mailing Address - Country:US
Mailing Address - Phone:402-871-1035
Mailing Address - Fax:
Practice Address - Street 1:705 S FREMONT ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1570
Practice Address - Country:US
Practice Address - Phone:712-246-4033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist