Provider Demographics
NPI:1699035428
Name:FERNANDEZ, LORETTA ELLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:ELLEN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:ELLEN
Other - Last Name:RIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:352-376-6062
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-374-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS503021835G0303X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric