Provider Demographics
NPI:1134496706
Name:HERNANDEZ, MANUEL JR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1645
Mailing Address - Country:US
Mailing Address - Phone:915-585-0491
Mailing Address - Fax:915-587-8763
Practice Address - Street 1:8050 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1645
Practice Address - Country:US
Practice Address - Phone:915-585-0491
Practice Address - Fax:915-587-8763
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist