Provider Demographics
NPI:1609462597
Name:MENDOTA PHARMACY INC
Entity Type:Organization
Organization Name:MENDOTA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FADHL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:559-382-2080
Mailing Address - Street 1:497 OLLER ST
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:CA
Mailing Address - Zip Code:93640-2312
Mailing Address - Country:US
Mailing Address - Phone:559-382-2080
Mailing Address - Fax:
Practice Address - Street 1:497 OLLER ST
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-2312
Practice Address - Country:US
Practice Address - Phone:559-382-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy