Provider Demographics
NPI:1912026972
Name:GONZALEZ, FERNANDO (RPH)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:GONZALEZ
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 1:70 EATON CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-6403
Mailing Address - Country:US
Mailing Address - Phone:917-991-5380
Mailing Address - Fax:
Practice Address - Street 1:2472 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5045
Practice Address - Country:US
Practice Address - Phone:917-991-5380
Practice Address - Fax:401-216-3118
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist