Healthcare Provider Details

I. General information

NPI: 1033255385
Provider Name (Legal Business Name): JANICE MARIE BOPP PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 N MICHIGAN ST
SOUTH BEND IN
46601-1228
US

IV. Provider business mailing address

22555 STANTON RD
LAKEVILLE IN
46536-9746
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-3184
  • Fax: 574-289-1940
Mailing address:
  • Phone: 574-784-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26015085
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: