Provider Demographics
NPI:1750796355
Name:POPKO, AMANDA MARIE
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:POPKO
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 1:175 S WILKES BARRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5040
Mailing Address - Country:US
Mailing Address - Phone:570-849-7582
Mailing Address - Fax:
Practice Address - Street 1:201 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3501
Practice Address - Country:US
Practice Address - Phone:570-283-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist