Provider Demographics
NPI:1487237087
Name:GONZALEZ-MARRERO, LORENA (PHARMD)
Entity type:Individual
Prefix:MS
First Name:LORENA
Middle Name:
Last Name:GONZALEZ-MARRERO
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 1:2235 ASHLEY CROSSING DR APT 2K
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5706
Mailing Address - Country:US
Mailing Address - Phone:843-480-3940
Mailing Address - Fax:
Practice Address - Street 1:3642 SAVANNAH HWY STE 132
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-7948
Practice Address - Country:US
Practice Address - Phone:843-573-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC103355974OtherDRIVER'S LICENSE
42891OtherLICENSE NUMBER
1381260OtherNABP