Provider Demographics
NPI:1043013626
Name:HERNANDEZ, GERARDO (PHARMD)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-1116
Mailing Address - Country:US
Mailing Address - Phone:915-667-3399
Mailing Address - Fax:
Practice Address - Street 1:5807 SW 45TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5291
Practice Address - Country:US
Practice Address - Phone:806-353-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist