Provider Demographics
NPI:1043412844
Name:MEDINA, NILDA (TECHNICAL PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:NILDA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:TECHNICAL PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT SANTA TERESITA CALLE SANTA LUISA 4462
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4636
Mailing Address - Country:US
Mailing Address - Phone:787-840-3237
Mailing Address - Fax:
Practice Address - Street 1:EXT SANTA TERESITA CALLE SANTA LUISA 4462
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4636
Practice Address - Country:US
Practice Address - Phone:787-840-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR678183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician