Provider Demographics
NPI:1962175067
Name:LOPEZ, MICHAEL KALE NATIVIDAD (PHARMD, MBA)
Entity type:Individual
Prefix:
First Name:MICHAEL KALE
Middle Name:NATIVIDAD
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 BUENA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2823
Mailing Address - Country:US
Mailing Address - Phone:808-690-7981
Mailing Address - Fax:
Practice Address - Street 1:290 BUENA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-2823
Practice Address - Country:US
Practice Address - Phone:808-690-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-4676183500000X
UT13253763-1701183500000X
NV23029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist