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NPI Code Detail

MEDICARE: TRACY LOPEZ

MEDICARE: TRACY LOPEZ
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
1183500000XPharmacist83336CA

General Provider Information

NPI Number : 1912506049
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LOPEZ
Provider Business Mailing Address
First Line : 8123 SUNRISE BLVD APT 172
Second Line :
City : CITRUS HEIGHTS
State : CA
Zip : 95610-1562
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6450 PONY EXPRESS TRL
Second Line :
City : POLLOCK PINES
State : CA
Zip : 95726-9601
Country : US
Telephone Number : 530-647-8013
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2020
Last Update Date : 10/20/2020

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Directions to “ TRACY LOPEZ ” Practice Location

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