MEDICARE: ERIK GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	68807	TX

General Provider Information

NPI Number	:	1003562588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK GONZALEZ

Provider Business Mailing Address
First Line	:	218 WOOD CIRCLE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-2058
Country	:	US
Telephone Number	:	832-312-1559
Fax Number	:

Provider Business Practice Location Address
First Line	:	12434 STATE HIGHWAY 249
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-3323
Country	:	US
Telephone Number	:	281-272-0050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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Directions to “ ERIK GONZALEZ ” Practice Location

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