Provider Demographics
NPI:1275675928
Name:GOMEZ, ZULMA IVELISSE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ZULMA
Middle Name:IVELISSE
Last Name:GOMEZ
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 1:440 VIA CAMPINA
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3098
Mailing Address - Country:US
Mailing Address - Phone:787-299-0792
Mailing Address - Fax:787-715-1771
Practice Address - Street 1:STREET 183 BO. HATO KM 1
Practice Address - Street 2:SAN LORENZO SHOPPING CENTER
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-715-1770
Practice Address - Fax:787-715-1771
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist