Provider Demographics
NPI:1043587033
Name:HERNANDEZ, NICOLAS PABLO SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:NICOLAS
Middle Name:PABLO
Last Name:HERNANDEZ
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 BARATARIA BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5304
Mailing Address - Country:US
Mailing Address - Phone:504-340-3592
Mailing Address - Fax:504-340-3617
Practice Address - Street 1:2564 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-5304
Practice Address - Country:US
Practice Address - Phone:504-340-3592
Practice Address - Fax:504-340-3617
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist