Provider Demographics
NPI:1437400314
Name:LOPEZ, JOSEPH MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARK
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W FIRST ST
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-9220
Mailing Address - Country:US
Mailing Address - Phone:970-464-5982
Mailing Address - Fax:
Practice Address - Street 1:2424 HIGHWAY 6 AND 50
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1109
Practice Address - Country:US
Practice Address - Phone:970-241-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist