Provider Demographics
NPI:1821514241
Name:LOPEZ, CARMEN LUISA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LUISA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CALLE CIPRES
Mailing Address - Street 2:MANSIONES DE LOS CEDROS
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-642-7776
Mailing Address - Fax:
Practice Address - Street 1:4 BO MONTELLANO
Practice Address - Street 2:FARMACIA REY 21
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-694-1200
Practice Address - Fax:787-694-1202
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist