Provider Demographics
NPI:1003288812
Name:RUBALCABA-LOPEZ, AARON (PHARMD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:RUBALCABA-LOPEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 RIMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7802
Mailing Address - Country:US
Mailing Address - Phone:719-248-1091
Mailing Address - Fax:
Practice Address - Street 1:8750 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7797
Practice Address - Country:US
Practice Address - Phone:719-282-9502
Practice Address - Fax:719-282-9553
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist