Provider Demographics
NPI:1609902014
Name:GONZALEZ, WANDA I (RPH)
Entity Type:Individual
Prefix:MISS
First Name:WANDA
Middle Name:I
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CALLE AMAPOLA
Mailing Address - Street 2:URB. LAS FLORES
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2428
Mailing Address - Country:US
Mailing Address - Phone:787-868-7754
Mailing Address - Fax:
Practice Address - Street 1:52 CALLE AMAPOLA
Practice Address - Street 2:URB. LAS FLORES
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-2428
Practice Address - Country:US
Practice Address - Phone:787-868-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist