Provider Demographics
NPI:1841947769
Name:LOPEZ, JOSE LUIS (PHARMD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
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 1:54 E PRICE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3508
Mailing Address - Country:US
Mailing Address - Phone:956-550-8908
Mailing Address - Fax:956-550-8911
Practice Address - Street 1:54 E PRICE RD STE 2
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3508
Practice Address - Country:US
Practice Address - Phone:956-550-8908
Practice Address - Fax:956-550-8911
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist