Provider Demographics
NPI:1821708322
Name:MENDEZ-VALLE, JUDITH NICOLE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:NICOLE
Last Name:MENDEZ-VALLE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 34TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8552
Mailing Address - Country:US
Mailing Address - Phone:570-801-0506
Mailing Address - Fax:
Practice Address - Street 1:201 34TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8552
Practice Address - Country:US
Practice Address - Phone:570-801-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist