Healthcare Provider Details

I. General information

NPI: 1013429281
Provider Name (Legal Business Name): JEAN C. RIVERA LOPEZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2017
Last Update Date: 10/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 LANHAM SEVERN RD
SEABROOK MD
20706-2642
US

IV. Provider business mailing address

9122 BALTIMORE AVE APT 4037
COLLEGE PARK MD
20740-1379
US

V. Phone/Fax

Practice location:
  • Phone: 301-577-5555
  • Fax:
Mailing address:
  • Phone: 787-399-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25393
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: