Provider Demographics
NPI:1265037006
Name:HERNANDEZ, KATELYN ELISABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELISABETH
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ELISABETH
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:411 SUSAN LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-9077
Mailing Address - Country:US
Mailing Address - Phone:862-354-1558
Mailing Address - Fax:
Practice Address - Street 1:411 SUSAN LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-9077
Practice Address - Country:US
Practice Address - Phone:862-354-1558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist