MEDICARE: DR. ANGELA MARIE HERNANDEZ PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS48817	FL

General Provider Information

NPI Number	:	1962769513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA MARIE HERNANDEZ PHARMD

Provider Business Mailing Address
First Line	:	340 SW 24TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2547
Country	:	US
Telephone Number	:	954-764-1584
Fax Number	:	954-525-3282

Provider Business Practice Location Address
First Line	:	340 SW 24TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-2547
Country	:	US
Telephone Number	:	954-764-1584
Fax Number	:	954-525-3282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/04/2013

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