Healthcare Provider Details

I. General information

NPI: 1760693725
Provider Name (Legal Business Name): MARIA HERNANDEZ PHAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE ALMODOVAR FARMACIA LA INMACULADA
JUNCOS PR
00777-3302
US

IV. Provider business mailing address

C#13 QUINTAS DE HUMACAO
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-734-4399
  • Fax: 787-734-2565
Mailing address:
  • Phone: 787-850-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3800
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: