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General NPI Number Information
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NPI Number | 1649731142
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Entity Type | Individual
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Provider Name | EGBERT HERNANDEZ NIEVES
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Gender | Male
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 121 CALLE CRUZ ORTIZ STELLA S
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City | HUMACAO
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State | PR
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Zip | 00791-3727
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Country | US
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Telephone | 787-285-0810
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE CEILAN #972 COUNTRY CLUB
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City | SAN JUAN
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State | PR
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Zip | 00924
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Country | US
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Telephone | 787-366-6403
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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 | 6590
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License Number State | PR
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