Healthcare Provider Details

I. General information

NPI: 1174786727
Provider Name (Legal Business Name): MONIQUE D LOPES-SERRAO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD VANTHCS-PHARMACY SERVICE(119)
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD VANTHCS-PHARMACY SERVICE(119)
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0556
  • Fax:
Mailing address:
  • Phone: 214-857-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number119291
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: