Provider Demographics
NPI:1932283363
Name:GOMEZ, IRENE ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:ELIZABETH
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7823 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4942
Mailing Address - Country:US
Mailing Address - Phone:201-869-1235
Mailing Address - Fax:201-221-9794
Practice Address - Street 1:7823 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4942
Practice Address - Country:US
Practice Address - Phone:201-869-1235
Practice Address - Fax:201-221-9794
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02239400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02239400OtherPHARMACIST LICENSE NUMBER