Provider Demographics
NPI:1801119250
Name:MENDILLO, LYNDY MARIE (RPH)
Entity type:Individual
Prefix:
First Name:LYNDY
Middle Name:MARIE
Last Name:MENDILLO
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 1:108 DOUGLAS HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-4724
Mailing Address - Country:US
Mailing Address - Phone:315-264-1429
Mailing Address - Fax:
Practice Address - Street 1:108 DOUGLAS HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-4724
Practice Address - Country:US
Practice Address - Phone:315-264-1429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist