Provider Demographics
NPI:1831845403
Name:MEDINA MATOS, ROBERTO CARLOS JESUS (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CARLOS JESUS
Last Name:MEDINA MATOS
Suffix:
Gender:M
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:UNIVERSITY GARDENS AUSUBO ST. J-23
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-7833
Mailing Address - Country:US
Mailing Address - Phone:787-237-0610
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPPING COURT, LOCAL 103-B
Practice Address - Street 2:AVE 65TH DE INFANTERIA ESQ. ROBERTO CLEMENTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-767-2626
Practice Address - Fax:787-767-2626
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist