Provider Demographics
NPI:1225361322
Name:FEJERAN, RAYANNA
Entity Type:Individual
Prefix:
First Name:RAYANNA
Middle Name:
Last Name:FEJERAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 CENTRAL AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1605
Mailing Address - Country:US
Mailing Address - Phone:505-242-2713
Mailing Address - Fax:505-766-6613
Practice Address - Street 1:2105 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1605
Practice Address - Country:US
Practice Address - Phone:505-242-2713
Practice Address - Fax:505-766-6613
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRR00007331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist