Provider Demographics
NPI:1073395463
Name:LOPEZ CAPITOL GROUP CORP DBA MELISSA'S PHARMACY
Entity Type:Organization
Organization Name:LOPEZ CAPITOL GROUP CORP DBA MELISSA'S PHARMACY
Other - Org Name:LOPEZ CAPITOL GROUP CORP DBA MELISSA'S PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-967-8586
Mailing Address - Street 1:11300 NW 87TH CT STE 109
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4516
Mailing Address - Country:US
Mailing Address - Phone:305-967-8586
Mailing Address - Fax:305-967-8421
Practice Address - Street 1:11300 NW 87TH CT STE 109
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4516
Practice Address - Country:US
Practice Address - Phone:305-967-8586
Practice Address - Fax:305-967-8421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy