Provider Demographics
NPI:1396801858
Name:POP, VIRGINIA (CPHT CERTIFIED PHARM)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:POP
Suffix:
Gender:F
Credentials:CPHT CERTIFIED PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20067N 110TH LANE
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-3331
Mailing Address - Country:US
Mailing Address - Phone:623-376-8411
Mailing Address - Fax:623-376-8411
Practice Address - Street 1:20067N 110TH LANE
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-3331
Practice Address - Country:US
Practice Address - Phone:623-376-8411
Practice Address - Fax:623-376-8411
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06516171M00000X
NY1101-0830-7336-813183700000X
IL183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
C60056371OtherMARICOPA MANAGED CARE SYS
AZ539231Medicaid