Provider Demographics
NPI:1114282696
Name:HERNANDEZ-CHANG, JUDIMITH (RPH)
Entity Type:Individual
Prefix:
First Name:JUDIMITH
Middle Name:
Last Name:HERNANDEZ-CHANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13971 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7006
Mailing Address - Country:US
Mailing Address - Phone:305-480-5828
Mailing Address - Fax:
Practice Address - Street 1:14012 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3001
Practice Address - Country:US
Practice Address - Phone:305-559-0010
Practice Address - Fax:305-559-0080
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist