Healthcare Provider Details

I. General information

NPI: 1336059583
Provider Name (Legal Business Name): MARIAM GONZALEZ PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1087
US

IV. Provider business mailing address

2937 SW 152ND AVE
MIAMI FL
33185-4611
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-4065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: