Provider Demographics
NPI:1730473224
Name:MEDINA, NORMA IVETTE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:IVETTE
Last Name:MEDINA
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 1:97 ESTANCIA REAL
Mailing Address - Street 2:URB. CAMINO REAL
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-955-5716
Mailing Address - Fax:
Practice Address - Street 1:97 ESTANCIA REAL
Practice Address - Street 2:URB. CAMINO REAL
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-955-5716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5375183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist