Provider Demographics
NPI:1346965373
Name:BOSQUES GOMEZ, GETZABETH ENID (PHARMD)
Entity type:Individual
Prefix:
First Name:GETZABETH
Middle Name:ENID
Last Name:BOSQUES GOMEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 NOSTRAND AVE APT 7V
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4721
Mailing Address - Country:US
Mailing Address - Phone:787-690-0309
Mailing Address - Fax:
Practice Address - Street 1:6817 BAY PARKWAY
Practice Address - Street 2:CVS
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:787-690-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty