Provider Demographics
NPI:1033756424
Name:GONZALEZ, ROBERT LOUIS III (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:GONZALEZ
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1512
Mailing Address - Country:US
Mailing Address - Phone:618-781-5383
Mailing Address - Fax:
Practice Address - Street 1:13987 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2943
Practice Address - Country:US
Practice Address - Phone:314-831-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019030609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty