Healthcare Provider Details

I. General information

NPI: 1588696843
Provider Name (Legal Business Name): ELIZABETH GONZALEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SAINT ROSE PKWY
HENDERSON NV
89052-3839
US

IV. Provider business mailing address

251 S GREEN VALLEY PKWY APT #811
HENDERSON NV
89012-2372
US

V. Phone/Fax

Practice location:
  • Phone: 702-616-5441
  • Fax:
Mailing address:
  • Phone: 702-616-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16508
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: