Provider Demographics
NPI:1770702482
Name:HENANDEZ, EVELYN (RPH)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:HENANDEZ
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 1:2643 PONCE BY PASS
Mailing Address - Street 2:CARR 2 INTER CALLE BARAMAYA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-267-6611
Mailing Address - Fax:787-267-6630
Practice Address - Street 1:2643 PONCE BY PASS
Practice Address - Street 2:CARR 2 INTER CALLE BARAMAYA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-267-6611
Practice Address - Fax:787-267-6630
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist