Provider Demographics
NPI:1447979091
Name:REYES LOPEZ, JENNIFFER CAROLINA
Entity type:Individual
Prefix:
First Name:JENNIFFER
Middle Name:CAROLINA
Last Name:REYES LOPEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5405
Mailing Address - Country:US
Mailing Address - Phone:281-996-9971
Mailing Address - Fax:
Practice Address - Street 1:701 W PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5405
Practice Address - Country:US
Practice Address - Phone:281-996-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74890183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes183500000XPharmacy Service ProvidersPharmacist