Provider Demographics
NPI:1164901963
Name:LOPEZ, ILEANA MARYS (PHARMD)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:MARYS
Last Name:LOPEZ
Suffix:
Gender:F
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:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:CASTANER
Mailing Address - State:PR
Mailing Address - Zip Code:00631-0285
Mailing Address - Country:US
Mailing Address - Phone:787-486-3415
Mailing Address - Fax:
Practice Address - Street 1:CARR 135 KM 64.2
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00631
Practice Address - Country:US
Practice Address - Phone:787-829-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR64251835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist