Provider Demographics
NPI:1154487502
Name:GONZALES, ELOISE B (RPH)
Entity Type:Individual
Prefix:
First Name:ELOISE
Middle Name:B
Last Name:GONZALES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 WELSH RD
Mailing Address - Street 2:G 4
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115
Mailing Address - Country:US
Mailing Address - Phone:215-951-8032
Mailing Address - Fax:215-951-8083
Practice Address - Street 1:ONE PENN BLVD
Practice Address - Street 2:GERMANTOWN COMMUNITY HEALTH SERVICES PHARMACY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144
Practice Address - Country:US
Practice Address - Phone:215-951-8030
Practice Address - Fax:215-951-8083
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027763L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist