Provider Demographics
NPI:1235551185
Name:GONZALES, CATHY (RPH)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
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 1:153 MOHICAN DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-5864
Mailing Address - Country:US
Mailing Address - Phone:843-527-2223
Mailing Address - Fax:843-546-3893
Practice Address - Street 1:1310 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2800
Practice Address - Country:US
Practice Address - Phone:843-527-2223
Practice Address - Fax:843-546-3893
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist