Healthcare Provider Details

I. General information

NPI: 1427584507
Provider Name (Legal Business Name): KATHRYN SUE LOPEZ R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 DOLSON CT
CARROLL OH
43112-9721
US

IV. Provider business mailing address

3675 DOLSON CT
CARROLL OH
43112-9721
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-0942
  • Fax: 740-653-7372
Mailing address:
  • Phone: 740-653-0942
  • Fax: 740-653-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03221369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: