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General NPI Number Information
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NPI Number | 1205312261
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Entity Type | Individual
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Provider Name | DR. SERGIO BARRANCO MEDINA
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Gender | Male
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 3171 RIVERPORT TECH CENTER DR
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-4825
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Country | US
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Telephone | 314-627-6121
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Fax | 314-983-0143
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Provider Business Mailing Address
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Address Line | 10275 CLAYTON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1115
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Country | US
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Telephone | 314-477-4532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2016019830
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License Number State | MO
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