Provider Demographics
NPI:1194096644
Name:MITCHELL, STEVEN (RPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MITCHELL
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 1:4365 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3607
Mailing Address - Country:US
Mailing Address - Phone:216-691-0897
Mailing Address - Fax:216-691-9394
Practice Address - Street 1:4365 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3607
Practice Address - Country:US
Practice Address - Phone:216-691-0897
Practice Address - Fax:216-691-9394
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03217811183500000X
FLPS0025292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist