Provider Demographics
NPI:1598975294
Name:HERNANDEZ, LOURDES
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
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 1731
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1731
Mailing Address - Country:US
Mailing Address - Phone:787-546-2984
Mailing Address - Fax:
Practice Address - Street 1:AVE.GENERAL RAMEY #1052
Practice Address - Street 2:POBLADO SAN ANTONIO
Practice Address - City:SAN ANTONIO
Practice Address - State:PR
Practice Address - Zip Code:00690
Practice Address - Country:US
Practice Address - Phone:787-890-3340
Practice Address - Fax:787-890-1233
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4646183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician