Provider Demographics
NPI:1295018869
Name:GONZALEZ, GUADALUPE (PHARM D)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 UNSER BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4640
Mailing Address - Country:US
Mailing Address - Phone:505-792-1992
Mailing Address - Fax:
Practice Address - Street 1:10700 UNSER BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-792-1992
Practice Address - Fax:505-792-1990
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00007373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist