MEDICARE: DR. SERGIO BARRANCO MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	2016019830	MO

General Provider Information

NPI Number	:	1205312261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGIO BARRANCO MEDINA

Provider Business Mailing Address
First Line	:	10275 CLAYTON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1115
Country	:	US
Telephone Number	:	314-477-4532
Fax Number	:

Provider Business Practice Location Address
First Line	:	3171 RIVERPORT TECH CENTER DR
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-4825
Country	:	US
Telephone Number	:	314-627-6121
Fax Number	:	314-983-0143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	09/01/2022

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