Healthcare Provider Details

I. General information

NPI: 1952501538
Provider Name (Legal Business Name): MONICA GOMEZ CAUBLE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 10/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 STATE STREET SUITE G
MADISON WI
53703
US

IV. Provider business mailing address

341 STATE STREET SUITE G
MADISON WI
53703
US

V. Phone/Fax

Practice location:
  • Phone: 608-251-4454
  • Fax: 608-251-3853
Mailing address:
  • Phone: 608-251-4454
  • Fax: 608-251-3853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45206
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1730340
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: