Provider Demographics
NPI:1043702640
Name:GONZALEZ, MARYELIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARYELIS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1596
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1596
Mailing Address - Country:US
Mailing Address - Phone:787-507-0886
Mailing Address - Fax:
Practice Address - Street 1:1 CARR 402
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2017
Practice Address - Country:US
Practice Address - Phone:787-229-1150
Practice Address - Fax:787-229-1160
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist