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General NPI Number Information
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NPI Number | 1548046832
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Entity Type | Individual
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Provider Name | RADIMILL GONZALEZ BURGOS PHAR-D
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Gender | Male
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Dates
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Enumeration Date | 09/04/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 7076 ATLANTA HWY
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City | MONTGOMERY
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State | AL
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Zip | 36117-4242
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Country | US
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Telephone | 334-290-4501
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Fax |
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Provider Business Mailing Address
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Address Line | 8562 FAIRHAVEN LN
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City | MONTGOMERY
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State | AL
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Zip | 36117-6324
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Country | US
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Telephone | 939-384-9102
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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 | 23248
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License Number State | AL
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