Provider Demographics
NPI:1609452606
Name:HERNANDEZ, GLADYS YVETT
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:YVETT
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 1:4955 BEECHNUT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1600
Mailing Address - Country:US
Mailing Address - Phone:713-664-4700
Mailing Address - Fax:866-422-6124
Practice Address - Street 1:4955 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1600
Practice Address - Country:US
Practice Address - Phone:713-664-4700
Practice Address - Fax:866-422-6124
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276562183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician