Provider Demographics
NPI:1760636880
Name:LOPEZ, IVONNE (RPH)
Entity Type:Individual
Prefix:MS
First Name:IVONNE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1625
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1625
Mailing Address - Country:US
Mailing Address - Phone:787-863-1477
Mailing Address - Fax:787-863-5207
Practice Address - Street 1:SANTA ISIDRA I CALLE 1 B-5
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-1477
Practice Address - Fax:787-863-5207
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2403183500000X
FLPS 25894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist