Provider Demographics
NPI:1396083580
Name:GOMEZ, CARLOS RAYMUNDO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RAYMUNDO
Last Name:GOMEZ
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 1:4320 DEERWOOD LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1177
Mailing Address - Country:US
Mailing Address - Phone:904-620-8344
Mailing Address - Fax:904-997-0575
Practice Address - Street 1:4320 DEERWOOD LAKE PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1177
Practice Address - Country:US
Practice Address - Phone:904-620-8344
Practice Address - Fax:904-997-0575
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist