Provider Demographics
NPI:1104107382
Name:GONZALEZ, NOEL ANTONIO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:ANTONIO
Last Name:GONZALEZ
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 1:10 CARR 149 STE DF007401
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-6204
Mailing Address - Country:US
Mailing Address - Phone:787-884-0404
Mailing Address - Fax:787-884-0100
Practice Address - Street 1:10 CARR 149 STE DF007401
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-6204
Practice Address - Country:US
Practice Address - Phone:787-884-0404
Practice Address - Fax:787-884-0100
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist