Provider Demographics
NPI:1538750971
Name:HERNANDEZ, GABRIELLA NICANDRA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLA
Middle Name:NICANDRA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5308
Mailing Address - Country:US
Mailing Address - Phone:626-755-4864
Mailing Address - Fax:
Practice Address - Street 1:9920 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1230
Practice Address - Country:US
Practice Address - Phone:626-443-3097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80867OtherCALIFORNIA BOARD OF PHARMACY