Provider Demographics
NPI:1407132871
Name:ALEJO-MEDINA, RANDY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:ALEJO-MEDINA
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 1:1110 W ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2806
Mailing Address - Country:US
Mailing Address - Phone:818-561-0086
Mailing Address - Fax:818-567-0792
Practice Address - Street 1:1110 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2806
Practice Address - Country:US
Practice Address - Phone:818-561-0086
Practice Address - Fax:818-567-0792
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH47535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist