Provider Demographics
NPI:1831623321
Name:LOPEZ, JEANNETTE M (RPH)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:M
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:PO BOX 801214
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1214
Mailing Address - Country:US
Mailing Address - Phone:787-290-1963
Mailing Address - Fax:
Practice Address - Street 1:CARR.132 KM 22.1
Practice Address - Street 2:BO CANAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-290-1963
Practice Address - Fax:787-841-0095
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist