MEDICARE: MARY-ANN 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	PS57535	FL

General Provider Information

NPI Number	:	1245726942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY-ANN GONZALEZ

Provider Business Mailing Address
First Line	:	3021 SW 92ND CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3133
Country	:	US
Telephone Number	:	305-790-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6391 BAYSHORE RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33917-3130
Country	:	US
Telephone Number	:	239-543-5312
Fax Number	:

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

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	07/05/2018

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