Provider Demographics
NPI:1588030175
Name:FERNANDEZ, JESUS PEDRO (PHARM D)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:PEDRO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5301
Mailing Address - Country:US
Mailing Address - Phone:305-300-2865
Mailing Address - Fax:
Practice Address - Street 1:5731 BIRD RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5301
Practice Address - Country:US
Practice Address - Phone:305-300-2865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist