Provider Demographics
NPI:1194376756
Name:HERNANDEZ, RAUL JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W GEORGIAN CT
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3313
Mailing Address - Country:US
Mailing Address - Phone:630-401-6284
Mailing Address - Fax:
Practice Address - Street 1:3045 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4131
Practice Address - Country:US
Practice Address - Phone:773-254-3316
Practice Address - Fax:773-254-1263
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051302388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist