Provider Demographics
NPI:1114457785
Name:SOTO-HERNANDEZ, DEEMARYS N (PHAMD)
Entity Type:Individual
Prefix:
First Name:DEEMARYS
Middle Name:N
Last Name:SOTO-HERNANDEZ
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BLVD DE LA MONTANA APT 660
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7030
Mailing Address - Country:US
Mailing Address - Phone:787-560-5011
Mailing Address - Fax:
Practice Address - Street 1:105 GILBERTO CONCEPCION DE GRACIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:787-725-2500
Practice Address - Fax:787-725-2526
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist