Provider Demographics
NPI:1689920712
Name:MEDRANO, ALBA YANET (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALBA
Middle Name:YANET
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5333
Mailing Address - Country:US
Mailing Address - Phone:561-632-4051
Mailing Address - Fax:
Practice Address - Street 1:5900 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3212
Practice Address - Country:US
Practice Address - Phone:561-963-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist