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General NPI Number Information
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NPI Number | 1235734211
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Entity Type | Individual
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Provider Name | MR. DONNY GONZALEZ MEDINA SR.
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Gender | Male
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 802 E 25TH ST
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City | HIALEAH
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State | FL
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Zip | 33013-3402
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Country | US
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Telephone | 305-450-4543
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 NW 178TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-3232
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Country | US
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Telephone | 305-450-4543
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Fax |
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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 | PS56940
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License Number State | FL
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