Healthcare Provider Details

I. General information

NPI: 1477788784
Provider Name (Legal Business Name): RYAN MATTHEW MENDOZA PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2009
Last Update Date: 05/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 CLEVELAND AVE NW
NORTH CANTON OH
44720-5658
US

IV. Provider business mailing address

7800 CLEVELAND AVE NW
NORTH CANTON OH
44720-5658
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-3448
  • Fax: 330-497-8253
Mailing address:
  • Phone: 330-499-3448
  • Fax: 330-497-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03228282
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: