Provider Demographics
NPI:1679073472
Name:MEDINA-RIVERA, PATRICIA I (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:I
Last Name:MEDINA-RIVERA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 CALLE 17
Mailing Address - Street 2:URBANIZACION LA ARBOLEDA
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:997 CALLE SAN ROBERTO
Practice Address - Street 2:PROFESSIONAL OFFICE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-773-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist