Individual
MARY GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
3240 WILLOWCREEK RD, PORTAGE, IN 46368-5055
(219) 762-3998
Mailing address
3240 WILLOWCREEK RD, PORTAGE, IN 46368-5055
(219) 762-3998
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26022134A
IN
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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