Provider Demographics
NPI:1740499979
Name:CHARLIE FERNANDEZ
Entity type:Organization
Organization Name:CHARLIE FERNANDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:FERNANDEZ
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-2050
Mailing Address - Street 1:HACIENDAS DE BORINQUEN
Mailing Address - Street 2:GUAYACAN A-27
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:787-306-3108
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2434
Practice Address - Country:US
Practice Address - Phone:787-897-2050
Practice Address - Fax:787-897-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5154183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty