Healthcare Provider Details

I. General information

NPI: 1235125410
Provider Name (Legal Business Name): KARL FREDERICK POPP R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 COLEMAN ST
CHATHAM NY
12037-1339
US

IV. Provider business mailing address

1775 DUCK POND ROAD
SCHODACK LANDING NY
12156-9712
US

V. Phone/Fax

Practice location:
  • Phone: 518-392-2616
  • Fax: 518-392-6678
Mailing address:
  • Phone: 518-732-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number028765
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033-0002304
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: