Provider Demographics
NPI:1518216852
Name:MITCHELL, KATIE D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 155TH ST
Mailing Address - Street 2:
Mailing Address - City:PACKWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:52580-8522
Mailing Address - Country:US
Mailing Address - Phone:319-863-3967
Mailing Address - Fax:
Practice Address - Street 1:400 E POLK ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1237
Practice Address - Country:US
Practice Address - Phone:319-863-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist