Provider Demographics
NPI:1790064079
Name:GONZALEZ-ROSA, ROBERTO (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:GONZALEZ-ROSA
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 1:2245 CALLE TANAMA
Mailing Address - Street 2:URB. RIO CANAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1835
Mailing Address - Country:US
Mailing Address - Phone:787-691-4688
Mailing Address - Fax:787-267-1074
Practice Address - Street 1:ROAD NO. 127 KM 23
Practice Address - Street 2:BO SUSUA BAJA
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-0415
Practice Address - Country:US
Practice Address - Phone:787-267-1110
Practice Address - Fax:787-267-1074
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist