Provider Demographics
NPI:1831404235
Name:GONZALEZ, ISAAC MARTINEZ (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:MARTINEZ
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:ISAAC
Other - Middle Name:M
Other - Last Name:GONZAELZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2130 CULEBRA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-6308
Mailing Address - Country:US
Mailing Address - Phone:210-737-1040
Mailing Address - Fax:
Practice Address - Street 1:2130 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-6308
Practice Address - Country:US
Practice Address - Phone:210-737-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist