Provider Demographics
NPI:1417122417
Name:MENDOZA, MICHELLE ERIKA (RPH)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ERIKA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 SUNTRAIL RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5835
Mailing Address - Country:US
Mailing Address - Phone:505-604-6417
Mailing Address - Fax:505-217-2395
Practice Address - Street 1:6250 PASEO DEL NORTE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1712
Practice Address - Country:US
Practice Address - Phone:505-217-2392
Practice Address - Fax:505-217-2395
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist