Provider Demographics
NPI:1073120796
Name:POPKEN, DEREK EUGENE
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:EUGENE
Last Name:POPKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 S 95TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-4282
Mailing Address - Country:US
Mailing Address - Phone:402-651-7607
Mailing Address - Fax:
Practice Address - Street 1:NEBRASKA MEDICINE
Practice Address - Street 2:987400 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-7400
Practice Address - Country:US
Practice Address - Phone:402-559-2484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist