Provider Demographics
NPI:1922817519
Name:HERNANDEZ, ENRIQUE JAVIER (RPH)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:JAVIER
Last Name:HERNANDEZ
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 1:7700 FORSYTH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1813
Mailing Address - Country:US
Mailing Address - Phone:314-725-4477
Mailing Address - Fax:
Practice Address - Street 1:4613 N UNIVERSITY DR # 142
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4602
Practice Address - Country:US
Practice Address - Phone:561-400-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist