Basic Information
Provider Information | |||||||||
NPI: | 1649876137 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LOPEZ RIVERA | ||||||||
FirstName: | NEFTALI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHARMD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | HC 45 BOX 10549 | ||||||||
Address2: |   | ||||||||
City: | CAYEY | ||||||||
State: | PR | ||||||||
PostalCode: | 007369634 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7872974078 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | CAROLINA SHOPPING COURT | ||||||||
Address2: | LOCAL 103B | ||||||||
City: | CAROLINA | ||||||||
State: | PR | ||||||||
PostalCode: | 00987 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877672626 | ||||||||
FaxNumber: | 7877672626 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/09/2020 | ||||||||
LastUpdateDate: | 12/10/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/10/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6836 | PR | Y |   | Pharmacy Service Providers | Pharmacist |   |
No ID Information.