Healthcare Provider Details

I. General information

NPI: 1508208810
Provider Name (Legal Business Name): SHARLYNNE GRACE FERNANDEZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2013
Last Update Date: 07/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

2147 W WALTON ST APT 2
CHICAGO IL
60622-4813
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2108
  • Fax:
Mailing address:
  • Phone: 708-202-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051296643
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: