Provider Demographics
NPI:1376832857
Name:GONZALES, MARIA R (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:R
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TONNELE AVE
Mailing Address - Street 2:NOBLE PHARMACY
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5412
Mailing Address - Country:US
Mailing Address - Phone:201-604-5812
Mailing Address - Fax:201-604-5815
Practice Address - Street 1:47 TONNELE AVE
Practice Address - Street 2:NOBLE PHARMACY
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5412
Practice Address - Country:US
Practice Address - Phone:201-604-5812
Practice Address - Fax:201-604-5815
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW00710000247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other