Provider Demographics
NPI:1467735878
Name:GONZALES, KRISTEN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5455 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5926
Mailing Address - Country:US
Mailing Address - Phone:770-381-1351
Mailing Address - Fax:
Practice Address - Street 1:5455 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5926
Practice Address - Country:US
Practice Address - Phone:770-381-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018989183500000X
GA025247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist