Provider Demographics
NPI:1023411477
Name:GONSALVES, BRENDAN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:GONSALVES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 W GRAND PKWY S
Mailing Address - Street 2:APARTMENT 811
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8442
Mailing Address - Country:US
Mailing Address - Phone:419-902-3596
Mailing Address - Fax:
Practice Address - Street 1:5161 FRANZ RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-1754
Practice Address - Country:US
Practice Address - Phone:281-391-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist