Provider Demographics
NPI:1467997379
Name:MEDINA, MARILYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 CURRAN BLVD APT 13D
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-5153
Mailing Address - Country:US
Mailing Address - Phone:786-302-7516
Mailing Address - Fax:
Practice Address - Street 1:1305 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3015
Practice Address - Country:US
Practice Address - Phone:985-641-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-01
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPS.021786183500000X
FLPS53479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist