Provider Demographics
NPI:1356620124
Name:HERNANDEZ LASSALLE, AIXA LYNN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:AIXA
Middle Name:LYNN
Last Name:HERNANDEZ LASSALLE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 AVE HOSTOS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00680
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1797
Practice Address - Country:US
Practice Address - Phone:787-831-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist