MEDICARE: IVETT HERNANDEZ PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS47795	FL

General Provider Information

NPI Number	:	1528342748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVETT HERNANDEZ PHARMD

Provider Business Mailing Address
First Line	:	1830 BEARBERRY CIR APT 105
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33559-8769
Country	:	US
Telephone Number	:	305-798-5728
Fax Number	:

Provider Business Practice Location Address
First Line	:	6429 GALL BLVD
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-2570
Country	:	US
Telephone Number	:	813-782-9571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	10/06/2011

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