Provider Demographics
NPI:1649371451
Name:GONZALEZ, EDDIE N SR (PH)
Entity type:Individual
Prefix:MRS
First Name:EDDIE
Middle Name:N
Last Name:GONZALEZ
Suffix:SR
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9906
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9906
Mailing Address - Country:US
Mailing Address - Phone:787-880-4806
Mailing Address - Fax:787-878-2065
Practice Address - Street 1:CARR.635 K.0.1 BO.DOMINGUITO
Practice Address - Street 2:BOX 9906
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-880-4806
Practice Address - Fax:787-878-2065
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000815183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician