Provider Demographics
NPI:1215116256
Name:MITCHELL, CARLA BRYANT (RPH)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:BRYANT
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 NW 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-8200
Mailing Address - Country:US
Mailing Address - Phone:954-648-9416
Mailing Address - Fax:954-578-2433
Practice Address - Street 1:2421 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6853
Practice Address - Country:US
Practice Address - Phone:954-781-0778
Practice Address - Fax:954-946-6154
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist