Organization
MENDOCINO PHARMACY HOLDINGS INC.
Active
Other names
Mendocino Village Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BRODETSKY PHARMD (PRESIDENT,DIRECTOR,SOLE OWNER,PIC)
(707) 734-0091
Entity
Organization
Contact information
Practice address
10501 LANSING ST., MENDOCINO, CA 95460-0904
(707) 937-4800
(707) 937-5800
Mailing address
PO BOX 904, MENDOCINO, CA 95460-0904
(707) 734-0091
(707) 962-3011
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHA459890
—
CA
Enumeration date
01/10/2018
Last updated
07/23/2020
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