Provider Demographics
NPI:1104930486
Name:LOPEZ, CELIA
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49510 COUNTY ROAD 681
Mailing Address - Street 2:P.O.BOX 69
Mailing Address - City:LAWRENCE
Mailing Address - State:MI
Mailing Address - Zip Code:49064-9047
Mailing Address - Country:US
Mailing Address - Phone:269-655-6137
Mailing Address - Fax:
Practice Address - Street 1:211 W MONROE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013-1330
Practice Address - Country:US
Practice Address - Phone:269-427-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician