Provider Demographics
NPI:1750652079
Name:HERNANDEZ, AZMATH FATIMA
Entity Type:Individual
Prefix:MRS
First Name:AZMATH
Middle Name:FATIMA
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 1:2142 MARATHON CT
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-2403
Mailing Address - Country:US
Mailing Address - Phone:863-604-1856
Mailing Address - Fax:
Practice Address - Street 1:5180 W IRLO BRONSON HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5346
Practice Address - Country:US
Practice Address - Phone:407-589-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0033987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist