Provider Demographics
NPI:1013505650
Name:HERNANDEZ, MIRIAM LOURDES (RPH)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:LOURDES
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6130
Mailing Address - Country:US
Mailing Address - Phone:813-877-5881
Mailing Address - Fax:813-870-1317
Practice Address - Street 1:2502 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6130
Practice Address - Country:US
Practice Address - Phone:813-877-5881
Practice Address - Fax:813-870-1317
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist