Provider Demographics
NPI:1326353103
Name:POPILLO, TONY JOSEPH (RPH)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:JOSEPH
Last Name:POPILLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 WARREN COLEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5885
Mailing Address - Country:US
Mailing Address - Phone:704-793-1331
Mailing Address - Fax:704-793-1335
Practice Address - Street 1:595 WARREN COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5885
Practice Address - Country:US
Practice Address - Phone:704-793-1331
Practice Address - Fax:704-793-1335
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18143183500000X
MA25025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist