Provider Demographics
NPI:1447474408
Name:HERNANDEZ, TONYA MICHELLE
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:MICHELLE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:MAYPEARL
Mailing Address - State:TX
Mailing Address - Zip Code:76064-0392
Mailing Address - Country:US
Mailing Address - Phone:972-435-2312
Mailing Address - Fax:
Practice Address - Street 1:1001 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2557
Practice Address - Country:US
Practice Address - Phone:972-923-2083
Practice Address - Fax:972-923-2084
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130739183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician