Provider Demographics
NPI:1962057372
Name:MEDINA, JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
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 1:181 GOLDENROD ST
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-4217
Mailing Address - Country:US
Mailing Address - Phone:832-231-5704
Mailing Address - Fax:
Practice Address - Street 1:2021 W PECAN ST
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3528
Practice Address - Country:US
Practice Address - Phone:512-251-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist