Provider Demographics
NPI:1033711502
Name:HERNANDEZ, RAY CONRAD ESPIRITU
Entity Type:Individual
Prefix:
First Name:RAY CONRAD
Middle Name:ESPIRITU
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 N PEBBLE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2571
Mailing Address - Country:US
Mailing Address - Phone:623-207-6808
Mailing Address - Fax:623-207-6814
Practice Address - Street 1:1654 N PEBBLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2571
Practice Address - Country:US
Practice Address - Phone:623-207-6808
Practice Address - Fax:623-207-6814
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist