Provider Demographics
NPI:1215798376
Name:BUTLER LOPEZ, GABRIELLE JOSUE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:JOSUE
Last Name:BUTLER LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0231
Mailing Address - Country:US
Mailing Address - Phone:939-267-8854
Mailing Address - Fax:
Practice Address - Street 1:CARR 140 KM 63.4
Practice Address - Street 2:BO. MAGUEYES, SECTOR FLORIDA AFUERA
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-846-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist