Provider Demographics
NPI:1841779006
Name:MITCHELL, WILLIAM HENRY (RPH)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:MITCHELL
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 1:3909 RAIN ROPER DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-0632
Mailing Address - Country:US
Mailing Address - Phone:406-599-5940
Mailing Address - Fax:
Practice Address - Street 1:6999 JACKRABBIT LN
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8961
Practice Address - Country:US
Practice Address - Phone:406-388-1713
Practice Address - Fax:406-388-1737
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist