Provider Demographics
NPI:1528663531
Name:HERNANDEZ, CHRISTINE ANN
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 WHITING FARMS RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2837
Mailing Address - Country:US
Mailing Address - Phone:413-532-3216
Mailing Address - Fax:413-533-3017
Practice Address - Street 1:250 WHITING FARMS RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2837
Practice Address - Country:US
Practice Address - Phone:413-532-3216
Practice Address - Fax:413-533-3017
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist