Provider Demographics
NPI:1538842760
Name:GONZALEZ, ALYSSA LOREN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:LOREN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 LOOKOUT
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-2341
Mailing Address - Country:US
Mailing Address - Phone:956-720-1610
Mailing Address - Fax:
Practice Address - Street 1:2301 N SHARY RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-3241
Practice Address - Country:US
Practice Address - Phone:956-585-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist