Individual
JOHN MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
EAST HIGHWAY 18, PINE RIDGE, SD 57770
(605) 867-3048
Mailing address
EAST HIGHWAY 18, PINE RIDGE, SD 57770
(605) 867-3048
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH60040238
WA
Other
Enumeration date
05/10/2010
Last updated
06/23/2021
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