Active NPI
Dawn Tracey Medina, RPH
- Pharmacist
- Hagerstown, MD
National Provider Identifier
1992963938
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15141
- Practice address
- 12817 Shank Farm Way
Hagerstown, MD 21742 - Phone
- (301) 665-9568
- Fax
- (301) 665-9798
- NPI assigned
- May 27, 2008
- Sex
- Female
- 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 | 15141 | MD | Primary |
Addresses
Primary practice location
12817 Shank Farm Way
Hagerstown, MD 21742
Mailing address
6125 Samuel Rd
New Market, MD 21774-6301
Phone (301) 865-4736
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15141 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211846400000",
"number": "1992963938",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6125 SAMUEL RD",
"city": "NEW MARKET",
"state": "MD",
"postal_code": "217746301",
"telephone_number": "301-865-4736",
"fax_number": "301-865-4736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12817 SHANK FARM WAY",
"city": "HAGERSTOWN",
"state": "MD",
"postal_code": "21742",
"telephone_number": "301-665-9568",
"fax_number": "301-665-9798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "DAWN",
"middle_name": "TRACEY",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-27",
"last_updated": "2008-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "15141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hagerstown, MD
- Medical Practices of Antietam, LLC
- Medical Practices of Antietam, LLC
- Medical Practices of Antietam, LLC
- Medical Practices of Antietam, LLC
- Andrea M Medina, LMSW
- Tamara Medina
- Medoville Pharmacy Inc.
- Medstar Health Weight Management, LLC
- Medstar Health Weight Management, LLC
- Medstar Health Weight Management, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.