Provider Demographics
NPI:1578898565
Name:LOPEZ, JUNMARY
Entity Type:Individual
Prefix:MISS
First Name:JUNMARY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:K8 CALLE ERNESTO RODRIGUEZ
Mailing Address - Street 2:VILLA SAN ANTON
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-6811
Mailing Address - Country:US
Mailing Address - Phone:787-689-6431
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL LITHEDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4597
Practice Address - Country:US
Practice Address - Phone:787-761-4205
Practice Address - Fax:787-761-1025
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7829183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician