Tim Mitchell Medical, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2003027740 Issued in MO

Legal business name

TIM MITCHELL MEDICAL, INC

Doing business as

Mitchell's Drug Store on the Boulevard

Practice address

719 S Neosho Blvd
Ste a
Neosho, MO 64850

Phone

(417) 451-9501

Fax

(417) 451-9594

NPI assigned

Sep 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tim Mitchell, R.PH.

Title

Owner/Manager

Phone

(417) 451-9501

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Mitchell's Drug Store on the Boulevard Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Tim Mitchell Medical, Inc

  dba Mitchell's Downtown Drug Store

  • Community/Retail Pharmacy
  • Neosho, MO
  • NPI 1184059784

  O20191204000110

  Same enrollment
• Tim Mitchell Medical, Inc

  dba Mitchell's Uptown Drug Store

  • Community/Retail Pharmacy
  • Neosho, MO
  • NPI 1316041353

  O20191204000110

  Same enrollment

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746057600000",
    "number": "1578669701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 S NEOSHO BLVD",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648502051",
            "telephone_number": "417-455-1883",
            "fax_number": "417-455-2781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 S NEOSHO BLVD",
            "address_2": "STE A",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "64850",
            "telephone_number": "417-451-9501",
            "fax_number": "417-451-9594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIM MITCHELL MEDICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "417-451-9501",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2003027740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "622932309",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200286710A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200642940A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602932303",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mitchell's Drug Store on the Boulevard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tim Mitchell Medical Inc (Mitchell's Drug Stores on the Boulevard)
• Tim Mitchell Medical Inc (Advantage Health Care)
• Tim Mitchell Medical, Inc (Mitchell's Downtown Drug Store)
• Tim Mitchell Medical, Inc (Mitchell's Uptown Drug Store)
• Tim Mitchell Medical, Inc (Mitchell's Long Term Care Pharmacy)
• Tim Mitchell Medical, Inc (Country Care Pharmacy)
• Tim Mitchell Medical, Inc. (Family Pharmacy of Neosho)
• Shelby L Tinney-Edge, DO
• Frank Tisdale, NP
• Lalanie Treasure

• Community/Retail Pharmacy in Neosho, MO
• Providers in Neosho, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.