Provider Demographics
NPI:1528464641
Name:LOPEZ, JOHANNA LIZETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LIZETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10675 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5645
Mailing Address - Country:US
Mailing Address - Phone:623-772-0502
Mailing Address - Fax:
Practice Address - Street 1:500 S 99TH AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-9700
Practice Address - Country:US
Practice Address - Phone:623-235-2360
Practice Address - Fax:623-235-2361
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021007183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist