Individual ProviderManuel Antonio MendezPharmacistPharmacy Service ProvidersPractice Address4229 Broadway, New York, NY 10033-3707(212) 781-6314PECOS EnrollmentBased on the most recent information from CMS, provider Manuel Antonio Mendez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 11 days ago.Profile DetailsProvider ID1700108883Provider TypeIndividualFull NameMendez, Manuel AntonioCredentialRPHGenderMaleSole ProprietorYesEnumeration Date2/17/2010Last Updated2/17/2010Contact InformationPractice LocationPractice Address4229 Broadway, New York, NY 10033-3707Phone(212) 781-6314Fax(212) 795-7343Mailing LocationMailing Address4229 Broadway, New York, NY 10033-3707Phone(212) 781-6314Fax(212) 795-7343Provider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense035186New YorkProvider IdentifiersIDDescriptionIssuerID035186DescriptionMedicaidIssuerUnlistedNew York