Provider Demographics
NPI:1255689907
Name:FERNANDEZ, TERESITA GIL (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:GIL
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 BISCAYNE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3138
Mailing Address - Country:US
Mailing Address - Phone:305-538-8838
Mailing Address - Fax:305-695-2168
Practice Address - Street 1:11645 BISCAYNE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3138
Practice Address - Country:US
Practice Address - Phone:305-538-8835
Practice Address - Fax:305-695-2168
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0032608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist