Provider Demographics
NPI:1023690062
Name:MEDRANO, LYNN VICTORIA (RPH)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:VICTORIA
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 S VIA BELAMARIA
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6626
Mailing Address - Country:US
Mailing Address - Phone:909-569-3250
Mailing Address - Fax:
Practice Address - Street 1:1086 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2492
Practice Address - Country:US
Practice Address - Phone:909-569-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist