Provider Demographics
NPI:1851646483
Name:HERNANDEZ, JAVIER (RPH)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4531
Mailing Address - Country:US
Mailing Address - Phone:413-733-8600
Mailing Address - Fax:
Practice Address - Street 1:85 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4531
Practice Address - Country:US
Practice Address - Phone:413-733-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236461835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric