Provider Demographics
NPI:1083760979
Name:LOPEZ SUAREZ, JENNIFFER
Entity Type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:
Last Name:LOPEZ SUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2497
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2497
Mailing Address - Country:US
Mailing Address - Phone:787-864-8060
Mailing Address - Fax:787-864-8061
Practice Address - Street 1:BARRIO PUENTE DE JOBOS
Practice Address - Street 2:CARR #3 KM 149.9
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-8060
Practice Address - Fax:787-864-8061
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4944OtherLIC DE FARMACEUTICA