Basic Information
| Provider Information | |||||||||
| NPI: | 1689173726 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98-1368 KOAHEAHE PL APT 180 | ||||||||
| Address2: | |||||||||
| City: | PEARL CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967823075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863512104 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 86-120 FARRINGTON HWY | ||||||||
| Address2: | |||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967923000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086967059 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH-4221 | HI | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.