Provider Demographics
NPI:1073899977
Name:POPKEN, STEPHANIE OLIVIA (PHARM D)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:OLIVIA
Last Name:POPKEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 N 95TH PLZ
Mailing Address - Street 2:APT 3
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2559
Mailing Address - Country:US
Mailing Address - Phone:402-305-1126
Mailing Address - Fax:
Practice Address - Street 1:17909 BURKE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2252
Practice Address - Country:US
Practice Address - Phone:402-289-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13648183500000X
IA21474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist