Provider Demographics
NPI:1326182452
Name:LOPEZ, LOUISETTE (BPHARM)
Entity Type:Individual
Prefix:MRS
First Name:LOUISETTE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BPHARM
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 686
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-0686
Mailing Address - Country:US
Mailing Address - Phone:787-405-5891
Mailing Address - Fax:787-895-0044
Practice Address - Street 1:SOCORRO ST A-1
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-6006
Practice Address - Fax:787-895-0044
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist