Provider Demographics
NPI:1912041070
Name:ZAIDA L. GONZALEZ
Entity Type:Organization
Organization Name:ZAIDA L. GONZALEZ
Other - Org Name:FARMACIA MIR-MAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ZAIDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ-ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-557-2554
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0966
Mailing Address - Country:US
Mailing Address - Phone:787-839-3440
Mailing Address - Fax:787-839-8103
Practice Address - Street 1:3 RIEFKHOL ST.
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-839-3440
Practice Address - Fax:787-839-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy