Provider Demographics
NPI:1356472443
Name:LOPEZ, LAURA IVETTE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:IVETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CALLE MIGUEL RIVERA TEXIDOR
Mailing Address - Street 2:ESTANCIAS DEL GOLF
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-0501
Mailing Address - Country:US
Mailing Address - Phone:787-432-3240
Mailing Address - Fax:787-842-8185
Practice Address - Street 1:14 CARR 123
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2708
Practice Address - Country:US
Practice Address - Phone:787-842-1314
Practice Address - Fax:787-842-8185
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR48991835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy