Individual
DR. ROBERT S MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
535 CENTRAL AVE, LOS ALAMOS, NM 87544-3202
(505) 662-4778
Mailing address
182 BLUE SPRUCE DR, JEMEZ SPRINGS, NM 87025-9069
(505) 662-4778
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP6576
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP006576
NEW MEXICO PHARMACIST LICENSE
NM
Enumeration date
09/27/2010
Last updated
09/27/2010
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