Provider Demographics
NPI:1417587304
Name:LOPEZ, DEANNA CELINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:CELINA
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 1:1174 FAIR OAKS AVE APT 38
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3853
Mailing Address - Country:US
Mailing Address - Phone:559-974-4871
Mailing Address - Fax:
Practice Address - Street 1:1758 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2293
Practice Address - Country:US
Practice Address - Phone:805-481-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist