Provider Demographics
NPI:1932414950
Name:HERNANDEZ, TRISHA ROSE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:ROSE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:TRISHA
Other - Middle Name:ROSE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3507 N CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6021
Mailing Address - Country:US
Mailing Address - Phone:309-363-2463
Mailing Address - Fax:
Practice Address - Street 1:2313 S MOUNT PROSPECT RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1811
Practice Address - Country:US
Practice Address - Phone:847-635-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist