Provider Demographics
NPI:1255874020
Name:POPTIC, SANDRA LEE (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:POPTIC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 PHAROAH DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9306
Mailing Address - Country:US
Mailing Address - Phone:614-596-9524
Mailing Address - Fax:614-340-6774
Practice Address - Street 1:1033 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2409
Practice Address - Country:US
Practice Address - Phone:614-340-6776
Practice Address - Fax:614-340-6774
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03318291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist