Provider Demographics
NPI:1891252862
Name:LOPEZ, ASHLEY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-7210
Mailing Address - Country:US
Mailing Address - Phone:307-760-4396
Mailing Address - Fax:
Practice Address - Street 1:1501 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4853
Practice Address - Country:US
Practice Address - Phone:307-635-5854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY4086OtherWYOMING BOARD OF PHARMACY