Provider Demographics
NPI:1982140323
Name:MANDEL, JACQUELYNN SOSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYNN
Middle Name:SOSA
Last Name:MANDEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 KOSTORYZ RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5021
Mailing Address - Country:US
Mailing Address - Phone:361-855-0860
Mailing Address - Fax:
Practice Address - Street 1:4444 KOSTORYZ RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5021
Practice Address - Country:US
Practice Address - Phone:361-855-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist