Provider Demographics
NPI:1427584507
Name:LOPEZ, KATHRYN SUE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SUE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 DOLSON CT
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9721
Mailing Address - Country:US
Mailing Address - Phone:740-653-0942
Mailing Address - Fax:740-653-7372
Practice Address - Street 1:3675 DOLSON CT
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9721
Practice Address - Country:US
Practice Address - Phone:740-653-0942
Practice Address - Fax:740-653-7372
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03221369OtherSTATE LICENSE