Provider Demographics
NPI:1992048243
Name:GOMEZ, ROBERTO MATTHEW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:MATTHEW
Last Name:GOMEZ
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CARSON DR SE UNIT 1601
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-3560
Mailing Address - Country:US
Mailing Address - Phone:719-502-0740
Mailing Address - Fax:
Practice Address - Street 1:25 OTERO RD
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-5707
Practice Address - Country:US
Practice Address - Phone:719-502-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist