Healthcare Provider Details

I. General information

NPI: 1689920712
Provider Name (Legal Business Name): ALBA YANET MEDRANO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LAKE WORTH RD
GREENACRES FL
33463-3212
US

IV. Provider business mailing address

4825 KIRKWOOD RD
LAKE WORTH FL
33461-5333
US

V. Phone/Fax

Practice location:
  • Phone: 561-963-3391
  • Fax:
Mailing address:
  • Phone: 561-632-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: