Provider Demographics
NPI:1003343476
Name:LORENZO MEDRANO, CAMILLE N (PHARM D)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:N
Last Name:LORENZO MEDRANO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0083
Mailing Address - Country:US
Mailing Address - Phone:787-934-8526
Mailing Address - Fax:
Practice Address - Street 1:580 MARGINAL BUCHANAN
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1706
Practice Address - Country:US
Practice Address - Phone:787-792-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist