Provider Demographics
NPI:1245390152
Name:POPE, NATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:POPE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 S LAMAR BLVD
Mailing Address - Street 2:STE D109-156
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8864
Mailing Address - Country:US
Mailing Address - Phone:512-965-8393
Mailing Address - Fax:512-672-6151
Practice Address - Street 1:1611 W 5TH ST
Practice Address - Street 2:STE 160
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4874
Practice Address - Country:US
Practice Address - Phone:512-965-8393
Practice Address - Fax:512-672-6151
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40777OtherPHARMACIST LICENSE