Provider Demographics
NPI:1992336374
Name:FERNANDEZ, MIGUEL ANGEL JR (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:FERNANDEZ
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6896
Mailing Address - Country:US
Mailing Address - Phone:956-208-2997
Mailing Address - Fax:
Practice Address - Street 1:708 N GRANT ST
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5310
Practice Address - Country:US
Practice Address - Phone:956-849-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist