Provider Demographics
NPI:1205023108
Name:POPE, JAMIE LISZKA (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LISZKA
Last Name:POPE
Suffix:
Gender:F
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-3853
Mailing Address - Country:US
Mailing Address - Phone:704-399-4611
Mailing Address - Fax:704-392-2790
Practice Address - Street 1:2701 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3853
Practice Address - Country:US
Practice Address - Phone:704-399-4611
Practice Address - Fax:704-392-2790
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC160161835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0607390Medicaid