Healthcare Provider Details

I. General information

NPI: 1730801077
Provider Name (Legal Business Name): JILL POPHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 DIXIE HWY
FT WRIGHT KY
41011-2698
US

IV. Provider business mailing address

1825 DIXIE HWY
FT WRIGHT KY
41011-2698
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-0370
  • Fax:
Mailing address:
  • Phone: 859-331-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011868
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: