Provider Demographics
NPI:1710224860
Name:FERNANDEZ, GINA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12026 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5682
Mailing Address - Country:US
Mailing Address - Phone:813-960-4403
Mailing Address - Fax:813-968-2807
Practice Address - Street 1:12026 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5682
Practice Address - Country:US
Practice Address - Phone:813-960-4403
Practice Address - Fax:813-968-2807
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist