Provider Demographics
NPI:1154756971
Name:GONZALEZ, JORGE EDUARDO (RPH)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:EDUARDO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 GALL BLVD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-4310
Mailing Address - Country:US
Mailing Address - Phone:813-783-8559
Mailing Address - Fax:813-780-1031
Practice Address - Street 1:7422 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-4310
Practice Address - Country:US
Practice Address - Phone:813-783-8559
Practice Address - Fax:813-780-1031
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL183500000XOtherPHARMACIST