Provider Demographics
NPI:1619077336
Name:FERNANDEZ, YAMNELYS (RPH)
Entity Type:Individual
Prefix:
First Name:YAMNELYS
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 COLLIN DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5012
Mailing Address - Country:US
Mailing Address - Phone:561-968-8690
Mailing Address - Fax:
Practice Address - Street 1:500 BELVEDERE RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1229
Practice Address - Country:US
Practice Address - Phone:561-659-7662
Practice Address - Fax:561-659-4364
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050513Medicare ID - Type Unspecified