Active NPI
Jacob Samuel Lopez, RPH
- Pharmacist
- Grants Pass, OR
National Provider Identifier
1699294868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0016203
- Practice address
- 111 Union Ave
Grants Pass, OR 97527-5579 - Phone
- (541) 471-4873
- NPI assigned
- Sep 19, 2017
- Last updated
- Sep 19, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0016203 | OR | Primary |
Addresses
Primary practice location
111 Union Ave
Grants Pass, OR 97527-5579
Mailing address
111 Union Ave
Grants Pass, OR 97527-5579
Phone (541) 471-4873
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0016203 | OR | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505779200000",
"number": "1699294868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 UNION AVE",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975275579",
"telephone_number": "541-471-4873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 UNION AVE",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975275579",
"telephone_number": "541-471-4873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "JACOB",
"middle_name": "SAMUEL",
"name_prefix": "Dr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-19",
"last_updated": "2017-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "0016203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.