Provider Demographics
NPI:1740810472
Name:HERNANDEZ, GRETCHEN AYMAR (RPH)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:AYMAR
Last Name:HERNANDEZ
Suffix:
Gender:F
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:URBANIZACION MARBELLA 15 CALLE MALLORCA
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-675-8624
Mailing Address - Fax:
Practice Address - Street 1:148 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5726
Practice Address - Country:US
Practice Address - Phone:787-675-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist