Provider Demographics
NPI:1669257671
Name:GONZALEZ RIBADENEIRA, CAMILA E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAMILA
Middle Name:E
Last Name:GONZALEZ RIBADENEIRA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COLD SPRING RD APT C202
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3118
Mailing Address - Country:US
Mailing Address - Phone:347-200-1093
Mailing Address - Fax:
Practice Address - Street 1:1312 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1824
Practice Address - Country:US
Practice Address - Phone:860-781-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist