1174673339 NPI number — LOPEZ PHARMACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174673339 NPI number — LOPEZ PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOPEZ PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174673339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5850 FM 802 STE C8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78526-5206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-838-0800
Provider Business Mailing Address Fax Number:
956-838-0802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5850 FM 802 STE C8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78526-5206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-838-0800
Provider Business Practice Location Address Fax Number:
956-838-0802
Provider Enumeration Date:
01/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
OWNER PHARMACIST
Authorized Official Telephone Number:
956-838-0800

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  23363 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4537405 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145441 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".