Provider Demographics
NPI:1538159249
Name:MITCHELL, KEVIN JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
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 1:281 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4027
Mailing Address - Country:US
Mailing Address - Phone:740-341-7714
Mailing Address - Fax:
Practice Address - Street 1:332 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5006
Practice Address - Country:US
Practice Address - Phone:740-382-0650
Practice Address - Fax:740-223-7566
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-17771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-2-17771OtherREGISTERED PHARMACIST