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General NPI Number Information
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NPI Number | 1235205956
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Entity Type | Individual
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Provider Name | MRS. CARMONA JOHANNA MICHELLE LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | FARMACIA SAGRADA FAMILIA BO CEDRO ARNBA
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City | NARANJITO
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State | PR
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Zip | 00719
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Country | US
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Telephone | 787-869-2741
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Fax |
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Provider Business Mailing Address
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Address Line | HC 72 BOX 3516
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City | NARANJITO
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State | PR
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Zip | 00719-9716
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Country | US
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Telephone | 787-869-2741
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 005145
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License Number State | PR
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