Provider Demographics
NPI:1740981059
Name:GONZALES, ALYSSA MYAN ALONSAGAY (BS PHARMACY)
Entity type:Individual
Prefix:
First Name:ALYSSA MYAN
Middle Name:ALONSAGAY
Last Name:GONZALES
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W BUSINESS 83
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5632
Mailing Address - Country:US
Mailing Address - Phone:956-447-3781
Mailing Address - Fax:956-968-9831
Practice Address - Street 1:1701 W BUSINESS 83
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5632
Practice Address - Country:US
Practice Address - Phone:956-447-3781
Practice Address - Fax:956-968-9831
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist