Provider Demographics
NPI:1740761055
Name:GONZALEZ, LUIS (RPH)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WALMART PUERTO RICO INC
Mailing Address - Street 2:16300 MONTE REAL PLAZA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-653-7777
Mailing Address - Fax:
Practice Address - Street 1:WALMART PUERTO RICO INC
Practice Address - Street 2:STATE ROAD #3 KM 15.2 BARRIO CANOVANILLAS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-653-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4105OtherRPH LICENSE NUMBER