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General NPI Number Information
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NPI Number | 1912668567
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Entity Type | Individual
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Provider Name | JOSUE GONZALEZ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 2015 FAYETTEVILLE RD
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City | VAN BUREN
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State | AR
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Zip | 72956-6537
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Country | US
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Telephone | 479-471-1608
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Fax |
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Provider Business Mailing Address
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Address Line | 4544 W PUTTING GREEN DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-7531
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Country | US
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Telephone | 479-208-2109
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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 | PD14134
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License Number State | AR
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