Healthcare Provider Details

I. General information

NPI: 1487960886
Provider Name (Legal Business Name): VALERIE ANN GONZALES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 MONTGOMERY BLVD NE #A
ALBUQUERQUE NM
87109-1308
US

IV. Provider business mailing address

5001 MONTGOMERY BLVD NE #A
ALBUQUERQUE NM
87109-1308
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-5210
  • Fax:
Mailing address:
  • Phone: 505-881-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006216
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-15695
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: