Provider Demographics
NPI:1811187610
Name:GONZALEZ, ILEAN Y (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:ILEAN
Middle Name:Y
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 2 H 36
Mailing Address - Street 2:METROPOLIS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-276-1927
Mailing Address - Fax:
Practice Address - Street 1:MONSERRATE SHOPPING CENTER MONSERRATE
Practice Address - Street 2:AVENUE, ROBERTO CLEMENTE CORNER
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-276-1927
Practice Address - Fax:787-762-4070
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1771183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician