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NPI Code Detail

MEDICARE: JONATHAN MENDONSA

MEDICARE: JONATHAN MENDONSA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist0202212420VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10202212420OTHERVABOARD OF PHARMACY LICENSE NUMBER

General Provider Information

NPI Number : 1154723047
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN MENDONSA
Provider Business Mailing Address
First Line : 4201 MEADOWDALE BLVD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23234-5465
Country : US
Telephone Number : 804-271-8100
Fax Number :
Provider Business Practice Location Address
First Line : 4201 MEADOWDALE BLVD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23234-5465
Country : US
Telephone Number : 804-271-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2014
Last Update Date : 09/23/2014

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