Provider Demographics
NPI:1609208115
Name:MORALES-GONZALEZ, AMANDA J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:MORALES-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 1:2901 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-3637
Mailing Address - Country:US
Mailing Address - Phone:708-863-6833
Mailing Address - Fax:708-391-2220
Practice Address - Street 1:2901 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3637
Practice Address - Country:US
Practice Address - Phone:708-863-6833
Practice Address - Fax:708-391-2220
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist