Provider Demographics
NPI:1326430604
Name:POPP, SHANNON K (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:K
Last Name:POPP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1804
Mailing Address - Country:US
Mailing Address - Phone:413-528-2860
Mailing Address - Fax:413-528-4588
Practice Address - Street 1:2878 STATE ROUTE 203
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-5722
Practice Address - Country:US
Practice Address - Phone:518-227-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234725183500000X
NY058127183500000X
FLPS52597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist