Provider Demographics
NPI:1376512095
Name:HERNANDEZ & SON CORP
Entity Type:Organization
Organization Name:HERNANDEZ & SON CORP
Other - Org Name:IDEAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-822-6548
Mailing Address - Street 1:344 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6719
Mailing Address - Country:US
Mailing Address - Phone:305-558-3551
Mailing Address - Fax:305-825-9420
Practice Address - Street 1:344 W 65TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6719
Practice Address - Country:US
Practice Address - Phone:305-558-3551
Practice Address - Fax:305-825-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0006042333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1146620001Medicare ID - Type Unspecified