Healthcare Provider Details

I. General information

NPI: 1679516892
Provider Name (Legal Business Name): LOPERS NEIGHBORHOOD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N US HIGHWAY 69
HUNTINGTON TX
75949-8910
US

IV. Provider business mailing address

PO BOX 1570
HUNTINGTON TX
75949-1570
US

V. Phone/Fax

Practice location:
  • Phone: 936-422-4440
  • Fax: 936-422-4667
Mailing address:
  • Phone: 936-422-4440
  • Fax: 936-422-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number25708
License Number StateTX

VIII. Authorized Official

Name: JERRY LOPER
Title or Position: OWNER, PRES, PIC
Credential: RPH
Phone: 936-422-4440