Healthcare Provider Details

I. General information

NPI: 1063134278
Provider Name (Legal Business Name): VICTORIA ANTOINETTE LOPEZ PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2677
US

IV. Provider business mailing address

11200 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2677
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-7477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00009729
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: