Provider Demographics
NPI:1093715229
Name:LOPEZ, EDNA M
Entity Type:Individual
Prefix:MISS
First Name:EDNA
Middle Name:M
Last Name:LOPEZ
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 1:904 CALLE 31 SO
Mailing Address - Street 2:LAS LOMAS RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2426
Mailing Address - Country:US
Mailing Address - Phone:787-799-2177
Mailing Address - Fax:787-279-0156
Practice Address - Street 1:904 CALLE 31 SO
Practice Address - Street 2:LAS LOMAS RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2426
Practice Address - Country:US
Practice Address - Phone:787-799-2177
Practice Address - Fax:787-279-0156
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist