Healthcare Provider Details

I. General information

NPI: 1184236820
Provider Name (Legal Business Name): RENZIO MENICO BANTAYAN APOSTOL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

2831 N HANALEI AVE
FRESNO CA
93737-0020
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number82776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: