Provider Demographics
NPI:1154474450
Name:MITCHELL, CHARLENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
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 1:331 TERESA DR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9504
Mailing Address - Country:US
Mailing Address - Phone:919-575-7674
Mailing Address - Fax:
Practice Address - Street 1:1003 12TH ST
Practice Address - Street 2:JOHN UMSTEAD HOSPITAL
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-1626
Practice Address - Country:US
Practice Address - Phone:919-575-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13101OtherNUMBER