Provider Demographics
NPI:1538345061
Name:FERNANDEZ, ROGELIO OSCAR (RPH)
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:OSCAR
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:ROGELIO
Other - Middle Name:OSCAR
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3920 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3708
Mailing Address - Country:US
Mailing Address - Phone:718-937-8159
Mailing Address - Fax:
Practice Address - Street 1:3920 29TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3708
Practice Address - Country:US
Practice Address - Phone:718-937-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist