Provider Demographics
NPI:1669524229
Name:GONZALEZ, RICKY G I (RPH)
Entity type:Individual
Prefix:MR
First Name:RICKY
Middle Name:G
Last Name:GONZALEZ
Suffix:I
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21303 PLAZA DE CADIZ
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1657
Mailing Address - Country:US
Mailing Address - Phone:210-867-9167
Mailing Address - Fax:
Practice Address - Street 1:11707 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1205
Practice Address - Country:US
Practice Address - Phone:210-558-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX42075OtherPHARMACY