MEDICARE: MICHELLE RODRIGUEZ LOPEZ

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	55491	TX

General Provider Information

NPI Number	:	1386248748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RODRIGUEZ LOPEZ

Provider Business Mailing Address
First Line	:	339 SHADBUSH ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2797
Country	:	US
Telephone Number	:	210-269-8314
Fax Number	:

Provider Business Practice Location Address
First Line	:	9006 GUILBEAU RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-2652
Country	:	US
Telephone Number	:	210-536-3158
Fax Number	:

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

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/25/2020

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