MEDICARE: DR. MAGALY ANTONIA HERNANDEZ-BOU LOPEZ

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	PS34583	FL

General Provider Information

NPI Number	:	1700123593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGALY ANTONIA HERNANDEZ-BOU LOPEZ

Provider Business Mailing Address
First Line	:	6790 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-3351
Country	:	US
Telephone Number	:	561-304-4983
Fax Number	:

Provider Business Practice Location Address
First Line	:	6790 FOREST HILL BLVD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33413-3351
Country	:	US
Telephone Number	:	561-304-4983
Fax Number	:

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

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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