MEDICARE: DR. MARCO LOUIS GONZALES PHARM.D.

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	48905	CA

General Provider Information

NPI Number	:	1265532832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCO LOUIS GONZALES PHARM.D.

Provider Business Mailing Address
First Line	:	3240 24TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-4452
Country	:	US
Telephone Number	:	916-736-3196
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 PROSPECT PARK DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-6017
Country	:	US
Telephone Number	:	916-861-1889
Fax Number	:

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/08/2007

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