Provider Demographics
NPI:1730552589
Name:MEDLIN, ANDREA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25080 HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5976
Mailing Address - Country:US
Mailing Address - Phone:951-677-4219
Mailing Address - Fax:
Practice Address - Street 1:1820 S SILVERSTONE WAY STE 200&300
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8860
Practice Address - Country:US
Practice Address - Phone:855-745-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist