Provider Demographics
NPI:1427529080
Name:MENDAZONA, JEANNE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:MENDAZONA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16204 SW VAQUEROS WAY
Mailing Address - Street 2:
Mailing Address - City:POWELL BUTTE
Mailing Address - State:OR
Mailing Address - Zip Code:97753-0411
Mailing Address - Country:US
Mailing Address - Phone:541-325-2069
Mailing Address - Fax:
Practice Address - Street 1:16204 SW VAQUEROS WAY
Practice Address - Street 2:
Practice Address - City:POWELL BUTTE
Practice Address - State:OR
Practice Address - Zip Code:97753-0411
Practice Address - Country:US
Practice Address - Phone:541-325-2069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0009286183500000X
OR92861835P0018X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist