Provider Demographics
NPI:1811407125
Name:GOMEZ, GISELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 NET DR APT 123
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5090
Mailing Address - Country:US
Mailing Address - Phone:786-975-3843
Mailing Address - Fax:
Practice Address - Street 1:4110 GEORGE RD STE 150
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7490
Practice Address - Country:US
Practice Address - Phone:813-206-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist