MEDICARE: ERNESTO GONZALEZ PHARMD

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	56981	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56981	OTHER	TX	TEXAS STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1164944187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTO GONZALEZ PHARMD

Provider Business Mailing Address
First Line	:	4420 DICKASON AVE APT 1233
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-6643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3800
Country	:	US
Telephone Number	:	214-953-0165
Fax Number	:

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

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	07/11/2017

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