Provider Demographics
NPI:1447747704
Name:MEDINA, EMILY DIANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DIANE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DIANE
Other - Last Name:FROMETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:13801 LANDSTAR BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5525
Mailing Address - Country:US
Mailing Address - Phone:407-723-4446
Mailing Address - Fax:
Practice Address - Street 1:13801 LANDSTAR BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5525
Practice Address - Country:US
Practice Address - Phone:407-723-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-21
Last Update Date:2018-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54902183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist