Provider Demographics
NPI:1679397061
Name:MEDEI, KIM (RPH)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:MEDEI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 HIBISCUS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1617
Mailing Address - Country:US
Mailing Address - Phone:407-921-8021
Mailing Address - Fax:
Practice Address - Street 1:5050 WESLEY RD STE 110
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5908
Practice Address - Country:US
Practice Address - Phone:866-943-4535
Practice Address - Fax:407-805-8545
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist