Provider Demographics
NPI:1861193781
Name:MITCHELL, GERRY ANN
Entity type:Individual
Prefix:
First Name:GERRY
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 FIVE CITIES DR
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3007
Mailing Address - Country:US
Mailing Address - Phone:805-773-1825
Mailing Address - Fax:
Practice Address - Street 1:531 FIVE CITIES DR
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3007
Practice Address - Country:US
Practice Address - Phone:805-773-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH3445183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician