Provider Demographics
NPI:1588950026
Name:LOPEZ, MARTA I
Entity type:Individual
Prefix:MISS
First Name:MARTA
Middle Name:I
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:FARMACIA WALGREENS # 12654
Mailing Address - Street 2:PLAZA CARIBE MALL
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-270-1079
Mailing Address - Fax:787-270-5020
Practice Address - Street 1:FARMACIA WALGREENS # 12654
Practice Address - Street 2:PLAZA CARIBE MALL
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-1079
Practice Address - Fax:787-270-5020
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist