Provider Demographics
NPI:1447565577
Name:MENDEZ-CROFFORD, JENE REBECCA (RPH)
Entity Type:Individual
Prefix:
First Name:JENE
Middle Name:REBECCA
Last Name:MENDEZ-CROFFORD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JENE
Other - Middle Name:REBECCA
Other - Last Name:CROFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2508 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3037
Mailing Address - Country:US
Mailing Address - Phone:512-448-3353
Mailing Address - Fax:512-912-1377
Practice Address - Street 1:2508 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3037
Practice Address - Country:US
Practice Address - Phone:512-448-3353
Practice Address - Fax:512-912-1377
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist