Healthcare Provider Details

I. General information

NPI: 1538819420
Provider Name (Legal Business Name): YANITZA HERNANDEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N WOOD AVE
LINDEN NJ
07036-4220
US

IV. Provider business mailing address

1154 70TH ST APT 1
NORTH BERGEN NJ
07047-3975
US

V. Phone/Fax

Practice location:
  • Phone: 908-587-2000
  • Fax:
Mailing address:
  • Phone: 201-682-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04232100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: