Healthcare Provider Details

I. General information

NPI: 1396639928
Provider Name (Legal Business Name): IVAN GONZALEZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10930 SW 138TH AVE
MIAMI FL
33186-3228
US

IV. Provider business mailing address

9315 SW 137TH AVE APT 306
MIAMI FL
33186-1447
US

V. Phone/Fax

Practice location:
  • Phone: 305-308-9632
  • Fax:
Mailing address:
  • Phone: 305-308-9632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: