Provider Demographics
NPI:1366727018
Name:HERNANDEZ, MARIO (RPH)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 NW 27TH ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8250 NW 27TH ST
Practice Address - Street 2:SUITE 311
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1904
Practice Address - Country:US
Practice Address - Phone:305-591-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist