Provider Demographics
NPI:1992204622
Name:GONZALEZ, VIRGEN Y (RPH)
Entity type:Individual
Prefix:
First Name:VIRGEN
Middle Name:Y
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 17651
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-9884
Mailing Address - Country:US
Mailing Address - Phone:787-868-1377
Mailing Address - Fax:
Practice Address - Street 1:CARR 115 KM 18.9
Practice Address - Street 2:BO RIO GRANDE
Practice Address - City:AGUADA PR
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty