Provider Demographics
NPI:1518316678
Name:MENDOZA TINOCO, MIGUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:MENDOZA TINOCO
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 1:1317 N MAIN ST
Mailing Address - Street 2:STE A11317
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-7342
Mailing Address - Country:US
Mailing Address - Phone:843-821-1360
Mailing Address - Fax:
Practice Address - Street 1:1317 N MAIN ST
Practice Address - Street 2:STE A11317
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7342
Practice Address - Country:US
Practice Address - Phone:843-821-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist