Provider Demographics
NPI:1407161284
Name:GAGE-GONZALEZ, ELAINE EVELYN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:EVELYN
Last Name:GAGE-GONZALEZ
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 1:19565 IH 35 S
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052
Mailing Address - Country:US
Mailing Address - Phone:830-772-4360
Mailing Address - Fax:830-709-2092
Practice Address - Street 1:19565 IH 35 S
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052
Practice Address - Country:US
Practice Address - Phone:830-772-4360
Practice Address - Fax:830-709-2092
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist