MEDICARE: SUWANNEE MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS41813	FL

General Provider Information

NPI Number	:	1518607712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUWANNEE MEDINA

Provider Business Mailing Address
First Line	:	3557 W 94TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-2080
Country	:	US
Telephone Number	:	786-395-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	3557 W 94TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-2080
Country	:	US
Telephone Number	:	786-395-8218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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Directions to “ SUWANNEE MEDINA ” Practice Location

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