Provider Demographics
NPI:1154972115
Name:MENDES, BRANDON ALEXANDER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ALEXANDER
Last Name:MENDES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SHEPARD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2025
Mailing Address - Country:US
Mailing Address - Phone:860-706-2264
Mailing Address - Fax:
Practice Address - Street 1:1745 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3520
Practice Address - Country:US
Practice Address - Phone:860-482-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist