Provider Demographics
NPI:1609495100
Name:POPELKA, DARYL JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:JOSEPH
Last Name:POPELKA
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 1:205 N E ST
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2016
Mailing Address - Country:US
Mailing Address - Phone:641-673-3439
Mailing Address - Fax:641-673-3945
Practice Address - Street 1:205 N E ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2016
Practice Address - Country:US
Practice Address - Phone:641-673-3439
Practice Address - Fax:641-673-3945
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist