Provider Demographics
NPI:1164775144
Name:MENDEL PHARMACY INC
Entity Type:Organization
Organization Name:MENDEL PHARMACY INC
Other - Org Name:MENDEL PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NNAMDI
Authorized Official - Last Name:ONYEACHONAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-735-2221
Mailing Address - Street 1:1264 BENNING RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5173
Mailing Address - Country:US
Mailing Address - Phone:301-735-2221
Mailing Address - Fax:301-735-2213
Practice Address - Street 1:1264 BENNING RD
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5173
Practice Address - Country:US
Practice Address - Phone:301-735-2221
Practice Address - Fax:301-735-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNO NUMBERMedicaid
MDNO NUMBERMedicare UPIN
MDNO NUMBERMedicaid
MDNO NUMBER TO ENTERMedicare PIN
MDNO NUMBERMedicare PIN