Provider Demographics
NPI:1487992400
Name:GOMEZ, NATHALIE R (PHARM D)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:R
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18485 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6817
Mailing Address - Country:US
Mailing Address - Phone:305-233-0128
Mailing Address - Fax:305-233-9537
Practice Address - Street 1:18485 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6817
Practice Address - Country:US
Practice Address - Phone:305-233-0128
Practice Address - Fax:305-233-9537
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist