Provider Demographics
NPI:1992045918
Name:HERNANDEZ, MAIRYM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAIRYM
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 AVE SAN IGNACIO
Mailing Address - Street 2:BOX 39
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4706
Mailing Address - Country:US
Mailing Address - Phone:787-657-4284
Mailing Address - Fax:
Practice Address - Street 1:1500 AVE SAN IGNACIO
Practice Address - Street 2:BOX 39
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4706
Practice Address - Country:US
Practice Address - Phone:787-657-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5541183500000X
FLPS48956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist