Healthcare Provider Details

I. General information

NPI: 1861309106
Provider Name (Legal Business Name): JUAN LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PARADISE RD
MODESTO CA
95351-3163
US

IV. Provider business mailing address

630 PLACID LN
MODESTO CA
95351-3127
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-3257
  • Fax: 209-575-4878
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH92686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: