Provider Demographics
NPI:1922442425
Name:HERNANDEZ, ARELIS
Entity Type:Individual
Prefix:MRS
First Name:ARELIS
Middle Name:
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 1:1 CALLE SAN MANUEL
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-2086
Mailing Address - Country:US
Mailing Address - Phone:787-859-2729
Mailing Address - Fax:787-802-4124
Practice Address - Street 1:1 CALLE SAN MANUEL
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2086
Practice Address - Country:US
Practice Address - Phone:787-859-2729
Practice Address - Fax:787-802-4124
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8845183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8845OtherJUNTA DE FARMACIA