Provider Demographics
NPI:1518694306
Name:IBARRA, LUPE S (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:LUPE
Middle Name:S
Last Name:IBARRA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-3111
Mailing Address - Country:US
Mailing Address - Phone:714-697-8288
Mailing Address - Fax:
Practice Address - Street 1:630 E 1ST ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3418
Practice Address - Country:US
Practice Address - Phone:714-544-7274
Practice Address - Fax:714-544-3517
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32590183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician