Provider Demographics
NPI:1891126744
Name:MENDOZA, SAMUEL VELORIA (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:VELORIA
Last Name:MENDOZA
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:USNH GUANTANAMO BAY
Mailing Address - Street 2:BOX 161
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09589-9997
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USNH GUANTANAMO BAY
Practice Address - Street 2:BOX 161
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09589-9997
Practice Address - Country:US
Practice Address - Phone:0115-399-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist