Provider Demographics
NPI:1417758590
Name:LOPEZ CALDERON, VIDA
Entity type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:LOPEZ CALDERON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8870 FONTAINEBLEAU BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4427
Mailing Address - Country:US
Mailing Address - Phone:786-269-6050
Mailing Address - Fax:
Practice Address - Street 1:8870 FONTAINEBLEAU BLVD APT 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4427
Practice Address - Country:US
Practice Address - Phone:786-269-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS675031835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist