Healthcare Provider Details

I. General information

NPI: 1699035428
Provider Name (Legal Business Name): LORETTA ELLEN FERNANDEZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORETTA ELLEN RIOS

II. Dates (important events)

Enumeration Date: 05/27/2012
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-6105
  • Fax:
Mailing address:
  • Phone: 352-376-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS50302
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS50302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: