Basic Information
| Provider Information | |||||||||
| NPI: | 1770702482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENANDEZ | ||||||||
| FirstName: | EVELYN | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2643 PONCE BY PASS | ||||||||
| Address2: | CARR 2 INTER CALLE BARAMAYA | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872676611 | ||||||||
| FaxNumber: | 7872676630 | ||||||||
| Practice Location | |||||||||
| Address1: | 2643 PONCE BY PASS | ||||||||
| Address2: | CARR 2 INTER CALLE BARAMAYA | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872676611 | ||||||||
| FaxNumber: | 7872676630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 3452 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.