Provider Demographics
NPI:1669908851
Name:SILVA MEDINA, CORAL ELISA (PHARMD)
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:ELISA
Last Name:SILVA 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 1:2333 BRICKELL AVE
Mailing Address - Street 2:APT2804
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2435
Mailing Address - Country:US
Mailing Address - Phone:786-942-6744
Mailing Address - Fax:
Practice Address - Street 1:2333 BRICKELL AVE
Practice Address - Street 2:APT2804
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129-2435
Practice Address - Country:US
Practice Address - Phone:786-942-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-07
Last Update Date:2017-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS56078OtherFLORIDA BOARD OF PHARMACY