Provider Demographics
NPI:1801105879
Name:GONZALEZ, RAQUEL MARIA (DPH)
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:MARIA
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 35
Mailing Address - Street 2:2484 FAYETTEVILLE HIGHWAY/
Mailing Address - City:BELFAST
Mailing Address - State:TN
Mailing Address - Zip Code:37019
Mailing Address - Country:US
Mailing Address - Phone:931-276-2234
Mailing Address - Fax:931-359-0109
Practice Address - Street 1:1800 MOORESVILLE HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2010
Practice Address - Country:US
Practice Address - Phone:931-270-6775
Practice Address - Fax:931-359-0109
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC005508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist