Provider Demographics
NPI:1710267208
Name:MARALIT, HICHELLE HERNANDEZ
Entity Type:Individual
Prefix:
First Name:HICHELLE
Middle Name:HERNANDEZ
Last Name:MARALIT
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 1:5804 SIERRA MEDINA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7484
Mailing Address - Country:US
Mailing Address - Phone:562-881-5439
Mailing Address - Fax:
Practice Address - Street 1:7845 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-4219
Practice Address - Country:US
Practice Address - Phone:702-871-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist