Provider Demographics
NPI:1306389218
Name:LOPEZ, DAVID RAMIRO (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RAMIRO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W 160TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4411
Mailing Address - Country:US
Mailing Address - Phone:310-406-9742
Mailing Address - Fax:
Practice Address - Street 1:1341 W 160TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4411
Practice Address - Country:US
Practice Address - Phone:310-406-9742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-24
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist