Provider Demographics
NPI:1477909729
Name:MANDRELL, JODI (PHARMD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:MANDRELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 W MORTON ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1617
Mailing Address - Country:US
Mailing Address - Phone:903-465-0048
Mailing Address - Fax:903-465-3492
Practice Address - Street 1:1926 W MORTON ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1617
Practice Address - Country:US
Practice Address - Phone:903-465-0048
Practice Address - Fax:903-465-3492
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist