Provider Demographics
NPI:1356748735
Name:FERNANDEZ, BAHATI (PHARMD)
Entity type:Individual
Prefix:
First Name:BAHATI
Middle Name:
Last Name:FERNANDEZ
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 1:4626 W DIVERSEY AVE
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1829
Mailing Address - Country:US
Mailing Address - Phone:773-628-1883
Mailing Address - Fax:773-628-1884
Practice Address - Street 1:4626 W DIVERSEY AVE
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1829
Practice Address - Country:US
Practice Address - Phone:773-628-1883
Practice Address - Fax:773-628-1884
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291921183500000X
OH033269823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist