Provider Demographics
NPI:1700426806
Name:GOMEZ, SHEILIE MARIE
Entity Type:Individual
Prefix:
First Name:SHEILIE
Middle Name:MARIE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 30 BOX 33854
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9739
Mailing Address - Country:US
Mailing Address - Phone:787-736-2900
Mailing Address - Fax:787-736-2800
Practice Address - Street 1:FARMACIA SAN MIGUEL
Practice Address - Street 2:216 CALLE MUNOZ RIVERA SUR SUITE 5
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-2900
Practice Address - Fax:787-736-2800
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist