Provider Demographics
NPI:1528602471
Name:GONZALEZ, TAMMY LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LEE
Last Name:GONZALEZ
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 1:5737 LIVE OAK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-8051
Mailing Address - Country:US
Mailing Address - Phone:214-212-2146
Mailing Address - Fax:
Practice Address - Street 1:399 W CAMPBELL RD STE 102
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3615
Practice Address - Country:US
Practice Address - Phone:214-212-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist