Healthcare Provider Details

I. General information

NPI: 1841100070
Provider Name (Legal Business Name): DIANA ANGELICA LOPEZ PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 E 130TH ST PH 1
CHICAGO IL
60628-6908
US

IV. Provider business mailing address

2811 W 36TH ST
CHICAGO IL
60632-1701
US

V. Phone/Fax

Practice location:
  • Phone: 773-941-6671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051308867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: