Provider Demographics
NPI:1669072799
Name:HERNANDEZ, MARIA DOLORES (PHARM D)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:HERNANDEZ
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 1:4312 BLUMENSHINE CIR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-5310
Mailing Address - Country:US
Mailing Address - Phone:505-289-7786
Mailing Address - Fax:
Practice Address - Street 1:1000 ROBERT RD
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-4012
Practice Address - Country:US
Practice Address - Phone:505-285-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000094031835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist