Provider Demographics
NPI:1548046832
Name:GONZALEZ BURGOS, RADIMILL (PHAR-D)
Entity type:Individual
Prefix:
First Name:RADIMILL
Middle Name:
Last Name:GONZALEZ BURGOS
Suffix:
Gender:M
Credentials:PHAR-D
Other - Prefix:
Other - First Name:RADIMILL
Other - Middle Name:
Other - Last Name:GONZALEZ BURGOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM-D
Mailing Address - Street 1:8562 FAIRHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6324
Mailing Address - Country:US
Mailing Address - Phone:939-384-9102
Mailing Address - Fax:
Practice Address - Street 1:7076 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4242
Practice Address - Country:US
Practice Address - Phone:334-290-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist