Organization
TIM MITCHELL MEDICAL, INC
Active
Other names
Mitchell's Drug Store on the Boulevard
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM MITCHELL R.PH. (OWNER/MANAGER)
(417) 451-9501
Entity
Organization
Contact information
Practice address
719 S NEOSHO BLVD, STE A, NEOSHO, MO 64850
(417) 451-9501
(417) 451-9594
Mailing address
719 S NEOSHO BLVD, NEOSHO, MO 64850-2051
(417) 455-1883
(417) 455-2781
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
2003027740
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200286710A
—
OK
05
—
200642940A
—
KS
05
—
602932303
—
MO
05
—
622932309
—
MO
Enumeration date
09/15/2006
Last updated
05/01/2025
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