Provider Demographics
NPI:1184139701
Name:MENDICINO, DARLENE M
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:M
Last Name:MENDICINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 NW 8TH AVE APT 809
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3022
Mailing Address - Country:US
Mailing Address - Phone:201-234-9617
Mailing Address - Fax:
Practice Address - Street 1:3550 NW 8TH AVE APT 809
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3022
Practice Address - Country:US
Practice Address - Phone:201-234-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01871200183500000X
FLPS63646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist