Healthcare Provider Details

I. General information

NPI: 1013281187
Provider Name (Legal Business Name): ROBERTA GAY HERNANDEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE SUITE 100
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

7454 TIMBERLANE PL
FISHERS IN
46038-2186
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-1437
  • Fax:
Mailing address:
  • Phone: 317-578-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number26017259A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: