Provider Demographics
NPI:1467628891
Name:HERNANDEZ, EDUARDO (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9961 SW 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6844
Mailing Address - Country:US
Mailing Address - Phone:305-382-0116
Mailing Address - Fax:305-382-0129
Practice Address - Street 1:9961 SW 142ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:305-382-0116
Practice Address - Fax:305-382-0129
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS39084OtherFLORIDA PHARMACY LICENSE