Provider Demographics
NPI:1114492022
Name:MENDIOLA, MARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E CAPITOL AVE APT 219
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7228
Mailing Address - Country:US
Mailing Address - Phone:562-786-7450
Mailing Address - Fax:
Practice Address - Street 1:1931 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3027
Practice Address - Country:US
Practice Address - Phone:831-768-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA772511835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care