Provider Demographics
NPI:1902225915
Name:HERNANDEZ, ALINA MICHELE
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:MICHELE
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 1:1700 S MOONSHADOW DR
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-7527
Mailing Address - Country:US
Mailing Address - Phone:928-246-0774
Mailing Address - Fax:
Practice Address - Street 1:1700 S MOONSHADOW DR
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-7527
Practice Address - Country:US
Practice Address - Phone:928-246-0774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT006742183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician