Provider Demographics
NPI:1902008113
Name:GONZALEZ-CLARKE, NEFER
Entity Type:Individual
Prefix:
First Name:NEFER
Middle Name:
Last Name:GONZALEZ-CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 7 BOX 7370
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:RI
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 844 KM 5.6
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:RI
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-760-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5821183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician