Provider Demographics
NPI:1780899625
Name:MENDOZA, RODOLFO (RPH)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WASHINGTON ST
Mailing Address - Street 2:PH - 3
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5591
Mailing Address - Country:US
Mailing Address - Phone:978-973-2478
Mailing Address - Fax:
Practice Address - Street 1:WENTWORTH-DOUGLASS HOSPITAL
Practice Address - Street 2:789 CENTRAL AVE
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-740-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist