Active NPI
John Medina
- Pharmacist
- Pine Ridge, SD
National Provider Identifier
1578881975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH60040238
- Practice address
- East Highway 18
Pine Ridge, SD 57770 - Phone
- (605) 867-3048
- NPI assigned
- May 10, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH60040238 | WA | Primary |
Addresses
Primary practice location
East Highway 18
Pine Ridge, SD 57770
Mailing address
East Highway 18
Pine Ridge, SD 57770
Phone (605) 867-3048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH60040238 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624406400000",
"number": "1578881975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "EAST HIGHWAY 18",
"city": "PINE RIDGE",
"state": "SD",
"postal_code": "57770",
"telephone_number": "605-867-3048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "EAST HIGHWAY 18",
"city": "PINE RIDGE",
"state": "SD",
"postal_code": "57770",
"telephone_number": "605-867-3048"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-10",
"last_updated": "2021-06-23",
"certification_date": "2021-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH60040238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Ridge, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.