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General NPI Number Information
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NPI Number | 1194376756
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Entity Type | Individual
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Provider Name | RAUL HERNANDEZ JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 3045 W 26TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-4131
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Country | US
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Telephone | 773-254-3316
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Fax | 773-254-1263
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Provider Business Mailing Address
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Address Line | 730 W GEORGIAN CT
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City | ADDISON
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State | IL
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Zip | 60101-3313
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Country | US
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Telephone | 630-401-6284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051302388
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License Number State | IL
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