Provider Demographics
NPI:1528393923
Name:MITCHELL, LORI JUNE (PHARM D)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JUNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9385
Mailing Address - Country:US
Mailing Address - Phone:910-821-6010
Mailing Address - Fax:910-821-6012
Practice Address - Street 1:8035 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9385
Practice Address - Country:US
Practice Address - Phone:910-821-6010
Practice Address - Fax:910-821-6012
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0105438Medicaid