MEDICARE: JESSICA LOPEZ DOCTOR OF PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	71164	TX

General Provider Information

NPI Number	:	1063133072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LOPEZ DOCTOR OF PHARMACY

Provider Business Mailing Address
First Line	:	10411 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1124
Country	:	US
Telephone Number	:	281-999-9963
Fax Number	:

Provider Business Practice Location Address
First Line	:	10411 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1124
Country	:	US
Telephone Number	:	281-999-9963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	09/07/2022

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