Healthcare Provider Details

I. General information

NPI: 1750652079
Provider Name (Legal Business Name): MRS. AZMATH FATIMA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 W IRLO BRONSON HWY
KISSIMMEE FL
34746-5346
US

IV. Provider business mailing address

2142 MARATHON CT
HAINES CITY FL
33844-2403
US

V. Phone/Fax

Practice location:
  • Phone: 407-589-2120
  • Fax:
Mailing address:
  • Phone: 863-604-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0033987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: