Provider Demographics
NPI:1639308752
Name:GONZALEZ PHARMACY, INC.
Entity Type:Organization
Organization Name:GONZALEZ PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY TECH
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:KAISHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-621-9586
Mailing Address - Street 1:1240 N HACIENDA BLVD
Mailing Address - Street 2:105
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1662
Mailing Address - Country:US
Mailing Address - Phone:626-918-4300
Mailing Address - Fax:626-918-4500
Practice Address - Street 1:1240 N HACIENDA BLVD
Practice Address - Street 2:105
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1662
Practice Address - Country:US
Practice Address - Phone:626-918-4300
Practice Address - Fax:626-918-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38459183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty