Provider Demographics
NPI:1407929490
Name:HERNANDEZ, VICTOR ENRIQUE (RPH)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ENRIQUE
Last Name:HERNANDEZ
Suffix:
Gender:M
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:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0306
Mailing Address - Country:US
Mailing Address - Phone:787-786-8221
Mailing Address - Fax:787-787-6822
Practice Address - Street 1:PR-2 KM 11.6 BAYAMON MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-786-8221
Practice Address - Fax:787-771-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist