Provider Demographics
NPI:1528780673
Name:LOPEZ, PAUL (CPHT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17049 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2976
Mailing Address - Country:US
Mailing Address - Phone:623-518-1063
Mailing Address - Fax:623-518-1064
Practice Address - Street 1:17049 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2976
Practice Address - Country:US
Practice Address - Phone:623-518-1063
Practice Address - Fax:623-518-1064
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT003936183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician