Provider Demographics
NPI:1992073167
Name:GONZALEZ, JORDAN S (PHARMD, CGP, RPH)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:S
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:PHARMD, CGP, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2702
Mailing Address - Country:US
Mailing Address - Phone:201-456-8730
Mailing Address - Fax:
Practice Address - Street 1:8 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2702
Practice Address - Country:US
Practice Address - Phone:201-456-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI030895001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy