Provider Demographics
NPI:1619318680
Name:GONZALEZ, JESSICA VICTORIA (PHARMD, CSPI)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:VICTORIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHARMD, CSPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 INVERNESS BAY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6726
Mailing Address - Country:US
Mailing Address - Phone:305-431-3664
Mailing Address - Fax:
Practice Address - Street 1:601 E 5TH ST STE 140
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3092
Practice Address - Country:US
Practice Address - Phone:704-248-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53914183500000X
NC27460183500000X
LAPNT.047149390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS53914OtherPHARMACIST LICENSE
NC27460OtherPHARMACIST LICENSE
NY086466OtherPHARMACY INTERN