MEDICARE: LOPERS NEIGHBORHOOD PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	26656	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2122641	OTHER		PK

General Provider Information

NPI Number	:	1245567213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOPERS NEIGHBORHOOD PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 1948
Second Line	:
City	:	HEMPHILL
State	:	TX
Zip	:	75948-1948
Country	:	US
Telephone Number	:	409-787-2345
Fax Number	:	409-787-2346

Provider Business Practice Location Address
First Line	:	2155 WORTH ST
Second Line	:
City	:	HEMPHILL
State	:	TX
Zip	:	75948-7249
Country	:	US
Telephone Number	:	409-787-2345
Fax Number	:	409-787-2346

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	JERRY LOPER
Credential	:	RPH
Telephone Number	:	936-422-4440

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	12/31/2014

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