Provider Demographics
NPI:1437726874
Name:MENDOZA, LINDSEY MICHELLE (CPHT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MICHELLE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S JOSEPHINE AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1844
Mailing Address - Country:US
Mailing Address - Phone:248-818-4357
Mailing Address - Fax:
Practice Address - Street 1:3273 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3638
Practice Address - Country:US
Practice Address - Phone:248-682-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician