Organization
MITCHELL CUSTOM CARE
Active
Other names
Live & Learn Compounding Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LEOTT WYDETIC PHRMD (OWNER)
(813) 341-1050
Entity
Organization
Contact information
Practice address
13224 BOYETTE RD, RIVERVIEW, FL 33569-5702
(813) 341-1050
(813) 341-1051
Mailing address
13224 BOYETTE RD, RIVERVIEW, FL 33569-5702
(813) 341-1050
(813) 341-1051
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH23267
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011692
PK
—
Enumeration date
05/28/2008
Last updated
04/01/2016
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