Healthcare Provider Details

I. General information

NPI: 1437290509
Provider Name (Legal Business Name): LEYDA LOPEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUPERFRAMACIA METROPOLIS CENTRO COMERCIAL METROPOLIS
CAROLINA PR
00987
US

IV. Provider business mailing address

PO BOX 1620
TRUJILLO ALTO PR
00977-1620
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-0090
  • Fax: 787-762-5049
Mailing address:
  • Phone: 787-762-5805
  • Fax: 787-752-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1848
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: