Provider Demographics
NPI:1629350426
Name:MENDIGUREN, JENNIFER RENEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:MENDIGUREN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:VENTRELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 PALM BCH LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33409
Mailing Address - Country:US
Mailing Address - Phone:561-615-0415
Mailing Address - Fax:
Practice Address - Street 1:220 PALM BCH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-615-0415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 48216183500000X
FLPS48216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist