Provider Demographics
NPI:1861763385
Name:LOPEZ, MARA SUAREZ (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MARA
Middle Name:SUAREZ
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7243 HOLLOWELL DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1086
Mailing Address - Country:US
Mailing Address - Phone:813-901-8558
Mailing Address - Fax:813-901-8567
Practice Address - Street 1:4141 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5631
Practice Address - Country:US
Practice Address - Phone:813-901-8558
Practice Address - Fax:813-901-8567
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist