MEDICARE: LOPEZ CAPITOL GROUP CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1073395463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOPEZ CAPITOL GROUP CORP

Provider Business Mailing Address
First Line	:	11300 NW 87TH CT STE 109
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4516
Country	:	US
Telephone Number	:	305-967-8586
Fax Number	:	305-967-8421

Provider Business Practice Location Address
First Line	:	11300 NW 87 CT
Second Line	:	SUITE 109
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4516
Country	:	US
Telephone Number	:	305-967-8586
Fax Number	:	305-967-8421

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YUSNIEL CORDERO DIAZ
Credential	:
Telephone Number	:	305-967-8586

Provider Enumeration Date	:	10/19/2023
Last Update Date	:	03/25/2026

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