Provider Demographics
NPI:1689173726
Name:GONZALEZ, ANTHONY GOVIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GOVIN
Last Name:GONZALEZ
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 1:1025 OPAKAPAKA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1887
Mailing Address - Country:US
Mailing Address - Phone:808-271-0511
Mailing Address - Fax:
Practice Address - Street 1:555 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3090
Practice Address - Country:US
Practice Address - Phone:808-271-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist