Provider Demographics
NPI:1124755491
Name:MITCHELL, BRANDI PAGE (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:PAGE
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 1:870 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2820
Mailing Address - Country:US
Mailing Address - Phone:207-854-8443
Mailing Address - Fax:207-854-9235
Practice Address - Street 1:870 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2820
Practice Address - Country:US
Practice Address - Phone:207-854-8443
Practice Address - Fax:207-854-9235
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR70613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist