Healthcare Provider Details

I. General information

NPI: 1669564894
Provider Name (Legal Business Name): JEAN SPALL POPHAM PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE SAVAHCS
TUCSON AZ
85723
US

IV. Provider business mailing address

3601 S 6TH AVE
TUCSON AZ
85723-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 520-792-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10823
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: