Healthcare Provider Details

I. General information

NPI: 1831744184
Provider Name (Legal Business Name): YVES GERALD GOMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 UNIVERSITY BLVD W
SILVER SPRING MD
20901-2440
US

IV. Provider business mailing address

9706 HEDIN DR
SILVER SPRING MD
20903-1815
US

V. Phone/Fax

Practice location:
  • Phone: 301-593-8092
  • Fax:
Mailing address:
  • Phone: 301-873-2766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26709
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: