Provider Demographics
NPI:1437699451
Name:LOPEZ, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:
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 1793
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1793
Mailing Address - Country:US
Mailing Address - Phone:787-672-5143
Mailing Address - Fax:
Practice Address - Street 1:320 CALLE AMBAR
Practice Address - Street 2:URB COSTA BRAVA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-1793
Practice Address - Country:US
Practice Address - Phone:787-672-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9765183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician