Provider Demographics
NPI:1730581471
Name:LOPEZ, BENJAMIN MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
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 1:2046 NE WALDO RD
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8975
Mailing Address - Country:US
Mailing Address - Phone:352-273-9045
Mailing Address - Fax:352-273-9658
Practice Address - Street 1:2046 NE WALDO RD
Practice Address - Street 2:SUITE 3100
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8975
Practice Address - Country:US
Practice Address - Phone:352-273-9045
Practice Address - Fax:352-273-9658
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist