Healthcare Provider Details

I. General information

NPI: 1497860506
Provider Name (Legal Business Name): SARAH JAYNE POPISH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

811 NW 30TH CT
WILTON MANORS FL
33311-1723
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1198
  • Fax:
Mailing address:
  • Phone: 208-602-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberP5958
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: