Provider Demographics
NPI:1801916663
Name:POPP, BRIAN GLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:GLEN
Last Name:POPP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1905 CR 177
Mailing Address - Street 2:
Mailing Address - City:HALLETTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77964
Mailing Address - Country:US
Mailing Address - Phone:361-798-1505
Mailing Address - Fax:361-798-1565
Practice Address - Street 1:1905 COUNTY ROAD 177
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964
Practice Address - Country:US
Practice Address - Phone:361-798-1505
Practice Address - Fax:361-798-1565
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist