Provider Demographics
NPI:1225371479
Name:GONZALEZ, EDMILLYVEE
Entity Type:Individual
Prefix:
First Name:EDMILLYVEE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX
Mailing Address - Street 2:2692
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-2692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URB. PARQUES DE GUASIMAS
Practice Address - Street 2:CALLE J 16
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-2692
Practice Address - Country:US
Practice Address - Phone:787-839-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008149183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician