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General NPI Number Information
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NPI Number | 1770796179
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Entity Type | Individual
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Provider Name | PHILLIP ERIC GONZALEZ PHARM D
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HWY 163 KAYENTA 2010
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City | KAYENTA
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State | AZ
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Zip | 86033
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Country | US
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Telephone | 928-697-4167
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Fax |
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Provider Business Mailing Address
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Address Line | 4945 N TENAYA WAY
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City | LAS VEGAS
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State | NV
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Zip | 89149-5703
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Country | US
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Telephone | 562-682-7489
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Fax | 702-870-9996
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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 | 16847
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License Number State | NV
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