Healthcare Provider Details

I. General information

NPI: 1629931506
Provider Name (Legal Business Name): GEORGE THOMAS POPPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E MARKLAND AVE
KOKOMO IN
46901-6236
US

IV. Provider business mailing address

307 SANDBROOK DR
NOBLESVILLE IN
46062-8177
US

V. Phone/Fax

Practice location:
  • Phone: 765-456-3641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26031610A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: