Organization
CRAYTON MITCHELL GROUP
Active
Other names
Space Coast Community Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TRACI MITCHELL (OWNER)
(321) 636-2275
Entity
Organization
Contact information
Practice address
197 BOUGAINVILLEA DR STE D, ROCKLEDGE, FL 32955-2402
(321) 636-2275
Mailing address
197 BOUGAINVILLEA DR STE D, ROCKLEDGE, FL 32955-2402
(321) 636-2275
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PH29873
FL
332BC3200X
Customized Equipment (DME)
PH29873
FL
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29873
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2158119
PK
—
Enumeration date
02/15/2016
Last updated
01/28/2020
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