Provider Demographics
NPI:1639176936
Name:GOMES, JOSEPH PAUL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:GOMES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 CAMERON DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1185
Mailing Address - Country:US
Mailing Address - Phone:847-838-1727
Mailing Address - Fax:847-838-1727
Practice Address - Street 1:648 CAMERON DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1185
Practice Address - Country:US
Practice Address - Phone:847-838-1727
Practice Address - Fax:847-838-1727
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 220551835P1200X
MA189111835P1200X
VA02020070421835P1200X
IN26020414A1835P1200X
IL1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy