Healthcare Provider Details

I. General information

NPI: 1821846668
Provider Name (Legal Business Name): RYAN LOPEZ RPH, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 PASEO DEL NORTE NE
ALBUQUERQUE NM
87113-1712
US

IV. Provider business mailing address

515 ROHAN RD NW
ALBUQUERQUE NM
87114-6193
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-2392
  • Fax: 505-217-2395
Mailing address:
  • Phone: 575-781-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010119
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: