Provider Demographics
NPI:1477124162
Name:GONZALEZ, JOSE ELIAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ELIAS
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W OCEAN BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-3682
Mailing Address - Country:US
Mailing Address - Phone:956-233-3400
Mailing Address - Fax:956-233-3402
Practice Address - Street 1:810 W OCEAN BLVD STE A1
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-3682
Practice Address - Country:US
Practice Address - Phone:956-233-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66926183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist