Provider Demographics
NPI:1649620949
Name:HOPPE, JESSE (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:HOPPE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 WILKES BARRE TOWNSHIP MARKET PL
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6059
Mailing Address - Country:US
Mailing Address - Phone:570-821-6190
Mailing Address - Fax:
Practice Address - Street 1:2150 WILKES BARRE TOWNSHIP MARKET PL
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6059
Practice Address - Country:US
Practice Address - Phone:570-821-6190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAR4477031835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR447703OtherPHARMACIST LICENSE