Provider Demographics
NPI:1588170799
Name:LOPEZ, SONIA E (RPH)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C20 CALLE 2
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-4383
Mailing Address - Country:US
Mailing Address - Phone:787-632-8664
Mailing Address - Fax:787-740-4462
Practice Address - Street 1:2114 CARR PR2 INT CALLE MORALES
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-2850
Practice Address - Fax:787-740-4462
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR02944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1271121OtherDRIVER'S LICENSE