Provider Demographics
NPI:1619224359
Name:GONZALE, ANGELA MARIE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:GONZALE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:JABER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2311 CAMINO HAULAPAI
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6265
Mailing Address - Country:US
Mailing Address - Phone:505-692-1025
Mailing Address - Fax:
Practice Address - Street 1:1096 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1654
Practice Address - Country:US
Practice Address - Phone:505-982-9811
Practice Address - Fax:505-982-1072
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist