Provider Demographics
NPI:1174741755
Name:EISNAUGLE, MENDY DANETTE (RPH)
Entity type:Individual
Prefix:
First Name:MENDY
Middle Name:DANETTE
Last Name:EISNAUGLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 TOWNSHIP ROAD 391
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-7987
Mailing Address - Country:US
Mailing Address - Phone:740-544-5759
Mailing Address - Fax:
Practice Address - Street 1:1820 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1949
Practice Address - Country:US
Practice Address - Phone:740-537-9425
Practice Address - Fax:740-537-9837
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-22238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist