Provider Demographics
NPI:1881981868
Name:LOPEZ, DAMARIS
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
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:PARQUE DEL RIO 121
Mailing Address - Street 2:VIA DEL PARQUE
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00967-6070
Mailing Address - Country:US
Mailing Address - Phone:787-287-0500
Mailing Address - Fax:787-287-0558
Practice Address - Street 1:121 VIA DEL PARQUE
Practice Address - Street 2:PARQUE DEL RIO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6070
Practice Address - Country:US
Practice Address - Phone:787-396-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist