Provider Demographics
NPI:1154100733
Name:BARRANCO, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BARRANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18524 OLD TRACE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3933
Mailing Address - Country:US
Mailing Address - Phone:225-603-0649
Mailing Address - Fax:
Practice Address - Street 1:15232 GEORGE ONEAL RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1507
Practice Address - Country:US
Practice Address - Phone:225-753-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist