Provider Demographics
NPI:1992129639
Name:GONZALEZ, KADY RAE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:KADY
Middle Name:RAE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:KADY
Other - Middle Name:RAE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6201 NORTH SUNCOAST BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428
Mailing Address - Country:US
Mailing Address - Phone:352-795-8360
Mailing Address - Fax:352-795-8352
Practice Address - Street 1:6201 NORTH SUNCOAST BOULEVARD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428
Practice Address - Country:US
Practice Address - Phone:352-795-8360
Practice Address - Fax:352-795-8352
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist