Healthcare Provider Details

I. General information

NPI: 1619174075
Provider Name (Legal Business Name): JOSE B. GONZALEZ SR. R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC-01 BOX 6007
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 474
UTUADO PR
00641-0474
US

V. Phone/Fax

Practice location:
  • Phone: 787-970-0839
  • Fax:
Mailing address:
  • Phone: 787-894-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4387
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: