Provider Demographics
NPI:1760082358
Name:MEDRANO, FERNANDO JR
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:MEDRANO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 DORADO DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-8590
Mailing Address - Country:US
Mailing Address - Phone:915-256-4785
Mailing Address - Fax:
Practice Address - Street 1:1400 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1601
Practice Address - Country:US
Practice Address - Phone:956-683-8895
Practice Address - Fax:956-683-0183
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist