Healthcare Provider Details

I. General information

NPI: 1164427936
Provider Name (Legal Business Name): DEBRA ANN LOPEZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 RED RIVER ST STE 100
AUSTIN TX
78701-1923
US

IV. Provider business mailing address

1604 AMELIA DR
CEDAR PARK TX
78613-3230
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8604
  • Fax:
Mailing address:
  • Phone: 512-257-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number38547
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: