Provider Demographics
NPI:1750429387
Name:GONZALEZ, MERCEDES GISELA (RPH,PHARMD)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:GISELA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPH,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 SW 93RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7759
Mailing Address - Country:US
Mailing Address - Phone:305-220-5115
Mailing Address - Fax:
Practice Address - Street 1:1830 SW 93RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7759
Practice Address - Country:US
Practice Address - Phone:305-220-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20780183500000X
FL3503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist