Provider Demographics
NPI:1578858627
Name:LOPEZ, MARY CHEUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHEUNG
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 S DIXIE HWY
Mailing Address - Street 2:T-1039
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7714
Mailing Address - Country:US
Mailing Address - Phone:305-668-8481
Mailing Address - Fax:305-668-8481
Practice Address - Street 1:8350 S DIXIE HWY
Practice Address - Street 2:T-1039
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7714
Practice Address - Country:US
Practice Address - Phone:305-668-8481
Practice Address - Fax:305-668-8481
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist