Provider Demographics
NPI:1215154547
Name:GONZALEZ, GUILLERMO JR (RPH)
Entity type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:
Last Name:GONZALEZ
Suffix:JR
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 1:4921 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2895
Mailing Address - Country:US
Mailing Address - Phone:956-631-2868
Mailing Address - Fax:
Practice Address - Street 1:1901 S COL ROWE BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1271
Practice Address - Country:US
Practice Address - Phone:956-687-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292981835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology