Provider Demographics
NPI:1164721841
Name:MENDYK, DANIEL J (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:MENDYK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 DELTA DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-4612
Mailing Address - Country:US
Mailing Address - Phone:989-249-9089
Mailing Address - Fax:
Practice Address - Street 1:1510 DELTA DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-4612
Practice Address - Country:US
Practice Address - Phone:989-249-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist