Healthcare Provider Details

I. General information

NPI: 1396679981
Provider Name (Legal Business Name): ALEXIS GERALDO GONZALEZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MALABAR RD NE
PALM BAY FL
32907-2506
US

IV. Provider business mailing address

2625 WASHINGTON ST
MELBOURNE FL
32904-6313
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-8000
  • Fax:
Mailing address:
  • Phone: 305-720-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS59818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: