Healthcare Provider Details

I. General information

NPI: 1194199513
Provider Name (Legal Business Name): KLARINDA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RAMSEY ST
FAYETTEVILLE NC
28301-7624
US

IV. Provider business mailing address

3300 RAMSEY ST
FAYETTEVILLE NC
28301-7624
US

V. Phone/Fax

Practice location:
  • Phone: 910-822-4965
  • Fax:
Mailing address:
  • Phone: 910-822-4965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: