Healthcare Provider Details

I. General information

NPI: 1043130735
Provider Name (Legal Business Name): KAYLEE MARIE POPPEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 JEFFERSON ST N
WADENA MN
56482-1372
US

IV. Provider business mailing address

321 JEFFERSON ST N
WADENA MN
56482-1372
US

V. Phone/Fax

Practice location:
  • Phone: 218-631-4050
  • Fax: 218-631-2726
Mailing address:
  • Phone: 218-631-4050
  • Fax: 218-631-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127413
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: