Provider Demographics
NPI:1598505992
Name:MITCHELL, CRYSTAL (RPH)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1308 GREEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-2026
Mailing Address - Country:US
Mailing Address - Phone:225-305-5222
Mailing Address - Fax:
Practice Address - Street 1:9960 BLUEBONNET BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6457
Practice Address - Country:US
Practice Address - Phone:225-768-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist