Provider Demographics
NPI:1457083883
Name:CONZUELO GABRIEL, ALEXA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:CONZUELO GABRIEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 S STEVENS ST APT 16
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1132
Mailing Address - Country:US
Mailing Address - Phone:253-754-1267
Mailing Address - Fax:
Practice Address - Street 1:3601 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5405
Practice Address - Country:US
Practice Address - Phone:253-761-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60965838390200000X
WAPH61459531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program