Provider Demographics
NPI:1659972388
Name:SOPKO, LEONA DE GUZMAN
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:DE GUZMAN
Last Name:SOPKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15495 PCB PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413
Mailing Address - Country:US
Mailing Address - Phone:850-708-6971
Mailing Address - Fax:850-708-6972
Practice Address - Street 1:15495 PCB PARKWAY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413
Practice Address - Country:US
Practice Address - Phone:850-708-6971
Practice Address - Fax:850-708-6972
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist