Provider Demographics
NPI:1104293448
Name:LOPEZ, TIA (PHARM D)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 1/2 SHARPTAIL ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6230
Mailing Address - Country:US
Mailing Address - Phone:870-577-4578
Mailing Address - Fax:
Practice Address - Street 1:2512 BROADWAY
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-2758
Practice Address - Country:US
Practice Address - Phone:970-257-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist