Provider Demographics
NPI:1437205036
Name:GOMEZ, MYRNA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MYRNA
Middle Name:
Last Name:GOMEZ
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:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-0244
Mailing Address - Country:US
Mailing Address - Phone:787-850-7232
Mailing Address - Fax:787-885-1595
Practice Address - Street 1:AVE LAURO PINERO 266
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-0266
Practice Address - Country:US
Practice Address - Phone:787-885-3010
Practice Address - Fax:787-885-1595
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist