Provider Demographics
NPI:1477153013
Name:LOPEZ, JOHNNY SEBASTIAN JR (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:SEBASTIAN
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7318 ELESSAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8821
Mailing Address - Country:US
Mailing Address - Phone:323-627-1934
Mailing Address - Fax:
Practice Address - Street 1:5940 LOSEE RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6591
Practice Address - Country:US
Practice Address - Phone:702-639-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist