Provider Demographics
NPI:1285279026
Name:MENDEZ HERNANDEZ, GLENDALIZ (PHARMD)
Entity type:Individual
Prefix:
First Name:GLENDALIZ
Middle Name:
Last Name:MENDEZ HERNANDEZ
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:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0533
Mailing Address - Country:US
Mailing Address - Phone:787-218-1779
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 434 K.M 4.3 BO CUCHILLAS
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-218-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist