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General NPI Number Information
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NPI Number | 1659991586
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Entity Type | Individual
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Provider Name | BILLY DAKOTA MEDLIN CPT
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Gender | Male
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 53 N 2ND ST
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City | ASHLAND
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State | OR
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Zip | 97520-1889
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Country | US
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Telephone | 541-428-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N PACIFIC HWY APT 107
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City | TALENT
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State | OR
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Zip | 97540-9505
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Country | US
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Telephone | 409-750-1258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | CPT-0010850
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License Number State | OR
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