Provider Demographics
NPI:1821388463
Name:LOPEZ, LEROY (RPH)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2992 F RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-4811
Mailing Address - Country:US
Mailing Address - Phone:970-241-3795
Mailing Address - Fax:970-241-4420
Practice Address - Street 1:2992 F RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-4811
Practice Address - Country:US
Practice Address - Phone:970-241-3795
Practice Address - Fax:970-241-4420
Is Sole Proprietor?:No
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist