Provider Demographics
NPI:1760822316
Name:LOPEZ, DENAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DENAE
Middle Name:
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 1:411 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4416
Mailing Address - Country:US
Mailing Address - Phone:707-443-8039
Mailing Address - Fax:707-443-1281
Practice Address - Street 1:411 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4416
Practice Address - Country:US
Practice Address - Phone:707-443-8039
Practice Address - Fax:707-443-1281
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68328183500000X
OR0013776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist