Healthcare Provider Details

I. General information

NPI: 1073120796
Provider Name (Legal Business Name): DEREK EUGENE POPKEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEBRASKA MEDICINE 987400 NEBRASKA MEDICAL CENTER
OMAHA NE
68198-7400
US

IV. Provider business mailing address

7213 S 95TH ST
LA VISTA NE
68128-4282
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-2484
  • Fax:
Mailing address:
  • Phone: 402-651-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14550
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: