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General NPI Number Information
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NPI Number | 1306442611
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Entity Type | Individual
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Provider Name | JONATHAN GONZALEZ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 123 GROVE ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4021
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Country | US
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Telephone | 973-744-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 22 PETTIT ST
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City | BLOOMFIELD
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State | NJ
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Zip | 07003-3921
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Country | US
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Telephone |
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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 | 28RI04144600
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License Number State | NJ
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