Provider Demographics
NPI:1356673016
Name:GONZALEZ, LYNETTE M
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:M
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:AVE. 65 INFANTERIA
Mailing Address - Street 2:# 22 ZENO GANDIA
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-3863
Mailing Address - Country:US
Mailing Address - Phone:939-452-6108
Mailing Address - Fax:
Practice Address - Street 1:CARR. 682 KM 6.7
Practice Address - Street 2:BOX 542
Practice Address - City:GARROCHALES
Practice Address - State:PR
Practice Address - Zip Code:00652-0542
Practice Address - Country:US
Practice Address - Phone:787-878-7608
Practice Address - Fax:787-846-7076
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist