Provider Demographics
NPI:1356954770
Name:MEDINA, EMETERIO (PHARMD / RPH)
Entity type:Individual
Prefix:
First Name:EMETERIO
Middle Name:
Last Name:MEDINA
Suffix:
Gender:M
Credentials:PHARMD / RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-7605
Mailing Address - Country:US
Mailing Address - Phone:909-672-4325
Mailing Address - Fax:
Practice Address - Street 1:3300 BROADWAY
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3809
Practice Address - Country:US
Practice Address - Phone:707-832-5274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist