Provider Demographics
NPI:1356574958
Name:GONZALES, BENNIE F (RPH)
Entity type:Individual
Prefix:MR
First Name:BENNIE
Middle Name:F
Last Name:GONZALES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9500 GOLF COURSE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4270
Mailing Address - Country:US
Mailing Address - Phone:505-897-7733
Mailing Address - Fax:
Practice Address - Street 1:9500 GOLF COURSE RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4270
Practice Address - Country:US
Practice Address - Phone:505-897-7733
Practice Address - Fax:505-897-3533
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-29
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRPH4148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist