Provider Demographics
NPI:1952629818
Name:MITCHELL, THOMAS PATRICK (RPH)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
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 1:18099 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5610
Mailing Address - Country:US
Mailing Address - Phone:216-476-7119
Mailing Address - Fax:216-476-9905
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5610
Practice Address - Country:US
Practice Address - Phone:216-476-7119
Practice Address - Fax:216-476-9905
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist