Provider Demographics
NPI:1447381173
Name:GONZALEZ MAHIQUEZ, IRAZEMA (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:IRAZEMA
Middle Name:
Last Name:GONZALEZ MAHIQUEZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 214 MUNOZ RIVERA #1
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:787-897-5398
Mailing Address - Fax:787-897-5398
Practice Address - Street 1:CALLE DR PEDRO ALB124
Practice Address - Street 2:CAMPOS #8
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-5398
Practice Address - Fax:787-897-5398
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-F-1860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist