Provider Demographics
NPI:1326599606
Name:POPA, DANIEL MARIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARIO
Last Name:POPA
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 1:2895 PAULING AVE APT 125
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2865
Mailing Address - Country:US
Mailing Address - Phone:951-833-6760
Mailing Address - Fax:
Practice Address - Street 1:2800 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2945
Practice Address - Country:US
Practice Address - Phone:509-783-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60676627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist