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General NPI Number Information
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NPI Number | 1083963649
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Entity Type | Individual
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Provider Name | JUAN CARLOS LOPEZ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 393 MAITLAND AVE
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5432
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Country | US
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Telephone | 407-260-7002
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Fax |
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Provider Business Mailing Address
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Address Line | 407 BAYWOOD CIR
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City | PORT ORANGE
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State | FL
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Zip | 32127-6119
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Country | US
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Telephone | 386-631-5421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS49706
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License Number State | FL
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