Provider Demographics
NPI:1750402657
Name:HERNANDEZ, ELBA
Entity type:Individual
Prefix:
First Name:ELBA
Middle Name:
Last Name:HERNANDEZ
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 1:2J73 CALLE JOSE M SOLIS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1127
Mailing Address - Country:US
Mailing Address - Phone:787-744-8451
Mailing Address - Fax:
Practice Address - Street 1:G30 CALLE MYRNA VAZQUEZ
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-2337
Practice Address - Country:US
Practice Address - Phone:787-258-1117
Practice Address - Fax:787-745-8470
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist