Provider Demographics
NPI:1275364945
Name:MEDINA, CAMILO ANDRES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAMILO
Middle Name:ANDRES
Last Name:MEDINA
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 1:1190 BIRCH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6230
Mailing Address - Country:US
Mailing Address - Phone:919-428-7084
Mailing Address - Fax:
Practice Address - Street 1:1575 W 84TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-4786
Practice Address - Country:US
Practice Address - Phone:303-427-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist