Provider Demographics
NPI:1235412719
Name:MENDONCA, KEVIN G (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:MENDONCA
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 1:220 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-2117
Mailing Address - Country:US
Mailing Address - Phone:401-434-1333
Mailing Address - Fax:
Practice Address - Street 1:220 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-2117
Practice Address - Country:US
Practice Address - Phone:401-434-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist