Healthcare Provider Details

I. General information

NPI: 1215798376
Provider Name (Legal Business Name): GABRIELLE JOSUE BUTLER LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 05/30/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 140 KM 63.4 BO. MAGUEYES, SECTOR FLORIDA AFUERA
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 231
HATILLO PR
00659-0231
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-7100
  • Fax:
Mailing address:
  • Phone: 939-267-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8107
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: