Healthcare Provider Details

I. General information

NPI: 1841410719
Provider Name (Legal Business Name): LUIS GONZALEZ III PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 FRANKLIN ST MEMORIAL MEDICAL CENTER
JOHNSTOWN PA
15905-4305
US

IV. Provider business mailing address

2108 TIMSON ST
JOHNSTOWN PA
15905-1855
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-9022
  • Fax:
Mailing address:
  • Phone: 814-255-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP031763L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: