Healthcare Provider Details

I. General information

NPI: 1518361468
Provider Name (Legal Business Name): LEONEL MENDIA JR. PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W ROOSEVELT RD
LOMBARD IL
60148-4219
US

IV. Provider business mailing address

345 W ROOSEVELT RD
LOMBARD IL
60148-4219
US

V. Phone/Fax

Practice location:
  • Phone: 630-629-4475
  • Fax: 630-629-4517
Mailing address:
  • Phone: 630-629-4475
  • Fax: 630-629-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051.298034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: