Provider Demographics
NPI:1477170249
Name:HERNANDEZ ZENGOTITA, CARMEN JANISELLE (PHARMACY INTERN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:JANISELLE
Last Name:HERNANDEZ ZENGOTITA
Suffix:
Gender:F
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 ASHURST ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2884
Mailing Address - Country:US
Mailing Address - Phone:407-433-2224
Mailing Address - Fax:
Practice Address - Street 1:200 PARK PLACE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2344
Practice Address - Country:US
Practice Address - Phone:407-344-9700
Practice Address - Fax:407-348-7100
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39288390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program