1043211030 NPI number — DR. DELWIN EDWARD MITCHELL PHARM.D.

Table of content: DR. DELWIN EDWARD MITCHELL PHARM.D. (NPI 1043211030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043211030 NPI number — DR. DELWIN EDWARD MITCHELL PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
DELWIN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043211030
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2745 GRINSTEAD DR
Provider Second Line Business Mailing Address:
APT 110
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40206-2899
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-580-2069
Provider Business Mailing Address Fax Number:
502-508-2069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2745 GRINSTEAD DR
Provider Second Line Business Practice Location Address:
APT. 110
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40206-2899
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-580-2069
Provider Business Practice Location Address Fax Number:
502-508-2069
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  17722 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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