Provider Demographics
NPI:1770883498
Name:LOPEZ, SOLOMON IVAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SOLOMON
Middle Name:IVAN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6382
Mailing Address - Country:US
Mailing Address - Phone:562-905-2805
Mailing Address - Fax:562-694-5805
Practice Address - Street 1:2101 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6382
Practice Address - Country:US
Practice Address - Phone:562-905-2805
Practice Address - Fax:562-694-5805
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist