Provider Demographics
NPI:1417295015
Name:MCGONIGAL, NATALIE FERNANDEZ
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:FERNANDEZ
Last Name:MCGONIGAL
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 1:1122 BICHARA BLVD
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-7716
Mailing Address - Country:US
Mailing Address - Phone:352-750-2424
Mailing Address - Fax:352-753-7982
Practice Address - Street 1:1122 BICHARA BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-7716
Practice Address - Country:US
Practice Address - Phone:352-750-2424
Practice Address - Fax:352-753-7982
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist