Provider Demographics
NPI:1427371780
Name:MEDINA, DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MEDINA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NASSAU TERMINAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4927
Mailing Address - Country:US
Mailing Address - Phone:516-280-1000
Mailing Address - Fax:516-280-1084
Practice Address - Street 1:75 NASSAU TERMINAL RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4997
Practice Address - Country:US
Practice Address - Phone:516-725-5944
Practice Address - Fax:516-208-1073
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist