Individual
JOHN JEROME HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9021 CAMERON ST, DUSON, LA 70529
(337) 873-6182
Mailing address
408 LEBESQUE RD, LAFAYETTE, LA 70507-5106
(337) 232-7127
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
9110
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9110
STATE LICENSE NUMBER
LA
Enumeration date
03/09/2007
Last updated
07/08/2007
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