Provider Demographics
NPI:1053605733
Name:MEDINA COLLAZO, PAOLA (PHARM D)
Entity type:Individual
Prefix:MISS
First Name:PAOLA
Middle Name:
Last Name:MEDINA COLLAZO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 180 KM 0.2, BO PUEBLO
Mailing Address - Street 2:BO.PUEBLO PLAZA SALINAS
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-3212
Mailing Address - Country:US
Mailing Address - Phone:787-824-5408
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS SALINAS CARR 180 KM 0.2
Practice Address - Street 2:BO.PUEBLO PLAZA SALINAS
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-3212
Practice Address - Country:US
Practice Address - Phone:787-824-5408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist