Provider Demographics
NPI:1285806430
Name:MENDENHALL, MATTHEW D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:MENDENHALL
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 1:2825 N KANSAS EXPY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-1017
Mailing Address - Country:US
Mailing Address - Phone:417-831-1000
Mailing Address - Fax:
Practice Address - Street 1:2825 N KANSAS EXPY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-1017
Practice Address - Country:US
Practice Address - Phone:417-831-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13585183500000X
MO2006024035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist