Provider Demographics
NPI:1427779917
Name:NICOLAS, PATRICIA KATE MENDOZA (PHARMD)
Entity type:Individual
Prefix:
First Name:PATRICIA KATE
Middle Name:MENDOZA
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:PATRICIA KATE
Other - Middle Name:MENDOZA
Other - Last Name:NICOLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2112 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7409
Mailing Address - Country:US
Mailing Address - Phone:214-404-3543
Mailing Address - Fax:
Practice Address - Street 1:2112 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7409
Practice Address - Country:US
Practice Address - Phone:214-404-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist