Provider Demographics
NPI:1295983468
Name:MENDENHALL, ANTHONY RAY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RAY
Last Name:MENDENHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13463 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-2724
Mailing Address - Country:US
Mailing Address - Phone:440-846-6152
Mailing Address - Fax:
Practice Address - Street 1:14701 PEARL RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-5026
Practice Address - Country:US
Practice Address - Phone:440-572-0455
Practice Address - Fax:440-268-0982
Is Sole Proprietor?:No
Enumeration Date:2008-08-30
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist