Provider Demographics
NPI:1639473358
Name:HERNANDEZ, FREDDY JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 WARBURTON AVE APT 6K
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1615
Mailing Address - Country:US
Mailing Address - Phone:917-627-2494
Mailing Address - Fax:
Practice Address - Street 1:679 WARBURTON AVE APT 6K
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1615
Practice Address - Country:US
Practice Address - Phone:917-627-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20054450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY20054450OtherSTATE LICENSE NUMBER