Provider Demographics
NPI:1720669054
Name:MEDINA, ARELYS (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ARELYS
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 W PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6520
Mailing Address - Country:US
Mailing Address - Phone:440-998-3777
Mailing Address - Fax:440-998-1471
Practice Address - Street 1:1115 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6520
Practice Address - Country:US
Practice Address - Phone:440-998-3777
Practice Address - Fax:440-998-1471
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09114528183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician