Provider Demographics
NPI:1447462049
Name:LOPEZ, AIDA JANET
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:JANET
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:BUZON 4 - 100 BO. LLANADAS
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0000
Mailing Address - Country:US
Mailing Address - Phone:787-830-6684
Mailing Address - Fax:787-872-2145
Practice Address - Street 1:BUZON 4 - 100 BO. LLANADAS
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0000
Practice Address - Country:US
Practice Address - Phone:787-830-6684
Practice Address - Fax:787-872-2145
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5096183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician