Individual
JON HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
01 SAGEBRUSH STREET, ISLETA, NM 87022
(505) 869-4866
Mailing address
PO BOX 640, ISLETA, NM 87022-0640
(505) 869-4866
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00006640
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RP00006640
LICENSE
NM
Enumeration date
08/21/2014
Last updated
08/21/2014
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