Provider Demographics
NPI:1790316180
Name:GONZALEZ, GILBERTO JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:
Last Name:GONZALEZ
Suffix:JR
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 1:1611 LILA BETH LN
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3184
Mailing Address - Country:US
Mailing Address - Phone:956-802-6820
Mailing Address - Fax:
Practice Address - Street 1:2121 E GRIFFIN PKWY STE 18
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3072
Practice Address - Country:US
Practice Address - Phone:956-519-6500
Practice Address - Fax:956-519-6524
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist