Individual
ALONZO BENJAMIN MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
6510 S COLUMBIA AVE, HAMMOND, IN 46320-2748
(219) 931-3332
Mailing address
2861 MINGO CT, PORTAGE, IN 46368-3707
(219) 763-3540
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26021321A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26021321A
PHARMACIST LICENSE
IN
Enumeration date
12/14/2006
Last updated
07/08/2007
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