Active NPI
Marcos Jonathan Gonzalez
- Pharmacist
- Goodyear, AZ
National Provider Identifier
1104607753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- S026726
- Practice address
- 14200 W Indian School Rd
Goodyear, AZ 85395-9248 - Phone
- (623) 935-7578
- NPI assigned
- Oct 10, 2023
- Last updated
- Oct 10, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S026726 | AZ | Primary |
Addresses
Primary practice location
14200 W Indian School Rd
Goodyear, AZ 85395-9248
Mailing address
14200 W Indian School Rd
Goodyear, AZ 85395-9248
Phone (623) 935-7578
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S026726 | AZ | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696896000000",
"number": "1104607753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14200 W INDIAN SCHOOL RD",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853959248",
"telephone_number": "623-935-7578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14200 W INDIAN SCHOOL RD",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853959248",
"telephone_number": "623-935-7578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "MARCOS",
"middle_name": "JONATHAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-10-10",
"last_updated": "2023-10-10",
"certification_date": "2023-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S026726",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.