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General NPI Number Information
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NPI Number | 1013063254
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Entity Type | Individual
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Provider Name | JILL MARIE GONZALO BSPH
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Gender | Female
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 W RIDGE PIKE 200 RIDGE PIKE
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-3702
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Country | US
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Telephone | 610-276-1000
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Fax | 610-276-1004
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Provider Business Mailing Address
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Address Line | 101 MOIR AVE
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City | WEST CONSHOHOCKEN
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State | PA
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Zip | 19428-2843
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Country | US
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Telephone | 610-828-4120
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Fax | 610-828-4120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP-095368L
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License Number State | PA
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