Provider Demographics
NPI:1700982238
Name:HERNANDEZ, ALFREDO JOSE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:JOSE
Last Name:HERNANDEZ
Suffix:
Gender:M
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:A9 CALLE ARACIBO
Mailing Address - Street 2:URB. CANEY
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-3552
Mailing Address - Country:US
Mailing Address - Phone:787-283-3260
Mailing Address - Fax:787-283-3486
Practice Address - Street 1:A9 CALLE ARACIBO
Practice Address - Street 2:URB. CANEY
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3552
Practice Address - Country:US
Practice Address - Phone:787-283-3260
Practice Address - Fax:787-283-3486
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5135OtherPHARMACIST STATE LICENSE