Provider Demographics
NPI:1154316479
Name:LOPEZ, KRISTINA LU (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LU
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LU
Other - Last Name:WYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:401 W. GREENLAWN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910
Mailing Address - Country:US
Mailing Address - Phone:517-975-7925
Mailing Address - Fax:517-975-7930
Practice Address - Street 1:401 W GREENLAWN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-975-7925
Practice Address - Fax:517-975-7930
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027686183500000X
MIMI5302027686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist