=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578898565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS JUNMARY LOPEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2009
-----------------------------------------------------
Last Update Date | 10/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CENTRO COMERCIAL LITHEDA
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926-4597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-761-4205
-----------------------------------------------------
Fax | 787-761-1025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | K8 CALLE ERNESTO RODRIGUEZ VILLA SAN ANTON
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00987-6811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-689-6431
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 7829
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------