Provider Demographics
NPI:1821345182
Name:LOPEZ, ALYSSA (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20376 N 55TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9100
Mailing Address - Country:US
Mailing Address - Phone:623-205-6494
Mailing Address - Fax:
Practice Address - Street 1:20266 N LAKE PLEASANT RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9711
Practice Address - Country:US
Practice Address - Phone:623-561-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist