Provider Demographics
NPI:1679516892
Name:LOPERS NEIGHBORHOOD PHARMACY INC
Entity Type:Organization
Organization Name:LOPERS NEIGHBORHOOD PHARMACY INC
Other - Org Name:LOPERS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRES, PIC
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:936-422-4440
Mailing Address - Street 1:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:75949-1570
Mailing Address - Country:US
Mailing Address - Phone:936-422-4440
Mailing Address - Fax:936-422-4667
Practice Address - Street 1:116 N US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:TX
Practice Address - Zip Code:75949-8910
Practice Address - Country:US
Practice Address - Phone:936-422-4440
Practice Address - Fax:936-422-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX257083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098855OtherPK
TX145641Medicaid