Provider Demographics
NPI:1508166232
Name:POPE, CASSANDRA BRADDOCK (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:BRADDOCK
Last Name:POPE
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 1:2912 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALKERTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27051-9324
Mailing Address - Country:US
Mailing Address - Phone:336-595-2638
Mailing Address - Fax:
Practice Address - Street 1:2912 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALKERTOWN
Practice Address - State:NC
Practice Address - Zip Code:27051-9324
Practice Address - Country:US
Practice Address - Phone:336-595-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist