Healthcare Provider Details

I. General information

NPI: 1750009155
Provider Name (Legal Business Name): IAN LAWRENCE MEDINA FLORESTA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 09/28/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE
WINTER HAVEN FL
33881-4193
US

IV. Provider business mailing address

3978 W HAMILTON KY
WEST PALM BEACH FL
33411-7442
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS63485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: