Provider Demographics
NPI:1619465200
Name:MENDOZA, MICHELLE ANN LIM (RPH)
Entity type:Individual
Prefix:MS
First Name:MICHELLE ANN
Middle Name:LIM
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CABRILLO HWY N
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1664
Mailing Address - Country:US
Mailing Address - Phone:650-726-6684
Mailing Address - Fax:650-726-1875
Practice Address - Street 1:60 CABRILLO HWY N
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1664
Practice Address - Country:US
Practice Address - Phone:650-726-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-29
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist