Provider Demographics
NPI:1689242414
Name:POPP, SANDRA ELIZABETH ANNE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELIZABETH ANNE
Last Name:POPP
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 1:168 KINGSBURY CT
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-1121
Mailing Address - Country:US
Mailing Address - Phone:610-746-0149
Mailing Address - Fax:
Practice Address - Street 1:575 RIVER ST --
Practice Address - Street 2:POST ACUTE MEDICAL - 7TH FLOOR
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-1870
Practice Address - Country:US
Practice Address - Phone:570-208-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038675R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty