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General NPI Number Information
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NPI Number | 1518397595
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Entity Type | Individual
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Provider Name | BENNIE GONZALES PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 55 MAUILANI PKWY
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City | WAILUKU
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State | HI
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Zip | 96793-2416
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Country | US
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Telephone | 808-243-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 55 MAUILANI PKWY
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City | WAILUKU
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State | HI
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Zip | 96793-2416
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Country | US
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Telephone | 808-243-6565
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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 | 3256
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 7185
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License Number State | NM
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