Provider Demographics
NPI:1790320661
Name:LOPEZ, ENNIE V (RPHP)
Entity Type:Individual
Prefix:MS
First Name:ENNIE
Middle Name:V
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPHP
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 356
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0356
Mailing Address - Country:US
Mailing Address - Phone:787-743-2000
Mailing Address - Fax:787-746-2001
Practice Address - Street 1:83 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3514
Practice Address - Country:US
Practice Address - Phone:787-743-2000
Practice Address - Fax:787-746-2001
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist