Provider Demographics
NPI:1881171965
Name:MENDOZA, CARLOS C III (RPH)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:C
Last Name:MENDOZA
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:CARLOS
Other - Middle Name:C
Other - Last Name:MENDOZA
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:12803 WEST AVE APT 19109
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1877
Mailing Address - Country:US
Mailing Address - Phone:432-294-3557
Mailing Address - Fax:
Practice Address - Street 1:17238 BULVERDE ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247
Practice Address - Country:US
Practice Address - Phone:210-495-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist