Provider Demographics
NPI:1194992693
Name:MITCHELL, KRISTINA MANTES (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MANTES
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:MANTES
Other - Last Name:ATENCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2104
Mailing Address - Country:US
Mailing Address - Phone:607-271-9480
Mailing Address - Fax:607-271-9486
Practice Address - Street 1:402 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2104
Practice Address - Country:US
Practice Address - Phone:607-271-9480
Practice Address - Fax:607-271-9486
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist