Provider Demographics
NPI:1053774067
Name:LOPEZ, CAROLYN (PHARM TECH)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHARM TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 75 BOX 1307
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9725
Mailing Address - Country:US
Mailing Address - Phone:787-359-1514
Mailing Address - Fax:
Practice Address - Street 1:HC 75 BOX 1307
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-9725
Practice Address - Country:US
Practice Address - Phone:787-359-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7526183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician