Provider Demographics
NPI:1902176381
Name:LOPEZ, SANDRA L
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:L
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 CALLE TOLOSA
Mailing Address - Street 2:URB. SULTANA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1431
Mailing Address - Country:US
Mailing Address - Phone:787-698-7966
Mailing Address - Fax:
Practice Address - Street 1:505 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1797
Practice Address - Country:US
Practice Address - Phone:787-831-0674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist