Provider Demographics
NPI:1104134675
Name:LANGSTON, MITCHELL RAY (RPH)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:RAY
Last Name:LANGSTON
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 1:24 CABLE CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-1996
Mailing Address - Country:US
Mailing Address - Phone:601-927-1514
Mailing Address - Fax:601-932-1121
Practice Address - Street 1:235 GEORGE WALLACE DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3524
Practice Address - Country:US
Practice Address - Phone:601-932-1660
Practice Address - Fax:601-932-1121
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-6463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist