Provider Demographics
NPI:1073281184
Name:MENDOZA, JURIZA-CHANTELLE DOMINGO (PHARMD)
Entity Type:Individual
Prefix:
First Name:JURIZA-CHANTELLE
Middle Name:DOMINGO
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 YELM AVE E
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7683
Mailing Address - Country:US
Mailing Address - Phone:360-458-8835
Mailing Address - Fax:
Practice Address - Street 1:1109 YELM AVE E
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7683
Practice Address - Country:US
Practice Address - Phone:360-458-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61185909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist