Provider Demographics
NPI:1144471848
Name:MITCHELL'S COMPOUNDING PHARMACY
Entity type:Organization
Organization Name:MITCHELL'S COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-255-8106
Mailing Address - Street 1:109 N TRENTON ST
Mailing Address - Street 2:#2
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4321
Mailing Address - Country:US
Mailing Address - Phone:318-255-8106
Mailing Address - Fax:
Practice Address - Street 1:109 N TRENTON ST
Practice Address - Street 2:#2
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4321
Practice Address - Country:US
Practice Address - Phone:318-255-8106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy