Provider Demographics
NPI:1972199834
Name:GOMEZ, EMILY D (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:D
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 1:2214 TRELLIS RIDGE LN APT 9
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4513
Mailing Address - Country:US
Mailing Address - Phone:262-758-7636
Mailing Address - Fax:
Practice Address - Street 1:2702 CALUMET DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-3835
Practice Address - Country:US
Practice Address - Phone:920-457-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2062740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist