Provider Demographics
NPI:1184053092
Name:BEJARANO, MIGUEL A (BS RPH)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:BEJARANO
Suffix:
Gender:M
Credentials:BS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 KILKENNEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8865
Mailing Address - Country:US
Mailing Address - Phone:704-882-6853
Mailing Address - Fax:704-882-7842
Practice Address - Street 1:2101 YOUNTS RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8505
Practice Address - Country:US
Practice Address - Phone:704-882-6853
Practice Address - Fax:704-882-7842
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist