Provider Demographics
NPI:1528458965
Name:MARRERO LOPEZ, IVETTE
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:MARRERO 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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0949
Mailing Address - Country:US
Mailing Address - Phone:787-510-2009
Mailing Address - Fax:
Practice Address - Street 1:SATURNINO RODRIGUEZ #30
Practice Address - Street 2:CIMA DRUG PHARMACY
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist