Provider Demographics
NPI:1275031759
Name:GONZALEZ, ELOI
Entity Type:Individual
Prefix:
First Name:ELOI
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9721 SW 131ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5614
Mailing Address - Country:US
Mailing Address - Phone:786-301-2639
Mailing Address - Fax:
Practice Address - Street 1:8950 N KENDALL DR STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2131
Practice Address - Country:US
Practice Address - Phone:305-273-8221
Practice Address - Fax:305-279-0421
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist