Provider Demographics
NPI:1205331360
Name:LOPEZ, MARIELA YTZEL (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:YTZEL
Last Name:LOPEZ
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 MIMOSA CIR
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6702
Mailing Address - Country:US
Mailing Address - Phone:956-437-5981
Mailing Address - Fax:
Practice Address - Street 1:708 N GRANT ST
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5310
Practice Address - Country:US
Practice Address - Phone:956-849-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66796183500000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program