MEDICARE: JANSEN MENDOZA LIWANAG RPH

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
1	183500000X	Pharmacist	62183	FL

General Provider Information

NPI Number	:	1316516222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANSEN MENDOZA LIWANAG RPH

Provider Business Mailing Address
First Line	:	1050 DOUGLAS AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2030
Country	:	US
Telephone Number	:	407-617-2399
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 E STATE ROAD 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5273
Country	:	US
Telephone Number	:	407-830-7350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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