Healthcare Provider Details

I. General information

NPI: 1235064601
Provider Name (Legal Business Name): RAFAEL HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9411 N OAK TRFY
KANSAS CITY MO
64155-2233
US

IV. Provider business mailing address

2800 CLAY EDWARDS DR
NORTH KANSAS CITY MO
64116-3220
US

V. Phone/Fax

Practice location:
  • Phone: 816-691-1255
  • Fax: 816-346-7297
Mailing address:
  • Phone: 816-691-1125
  • Fax: 816-346-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2016034967
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: