Provider Demographics
NPI:1235656703
Name:LOPICCOLA, RENEE CHARLOTTE (RPH)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CHARLOTTE
Last Name:LOPICCOLA
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 1:3065 182ND PL
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3006
Mailing Address - Country:US
Mailing Address - Phone:708-837-5568
Mailing Address - Fax:
Practice Address - Street 1:9301 CONNECTICUT DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7486
Practice Address - Country:US
Practice Address - Phone:219-769-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018814A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist