Provider Demographics
NPI:1255455739
Name:FERNANDEZ, ADELSO (RPH)
Entity type:Individual
Prefix:
First Name:ADELSO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SHERMAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2503
Mailing Address - Country:US
Mailing Address - Phone:212-567-1115
Mailing Address - Fax:212-567-1991
Practice Address - Street 1:232 SHERMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2503
Practice Address - Country:US
Practice Address - Phone:212-567-1115
Practice Address - Fax:212-567-1991
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047890183500000X
GARPH023992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist