Healthcare Provider Details

I. General information

NPI: 1053661397
Provider Name (Legal Business Name): JEFFREY MICHAEL POPE PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 NORTH DIXIE HIGHWAY
DAYTON OH
45414
US

IV. Provider business mailing address

3700 NORTH DIXIE HIGHWAY
DAYTON OH
45414
US

V. Phone/Fax

Practice location:
  • Phone: 937-275-7032
  • Fax: 937-278-0430
Mailing address:
  • Phone: 937-275-7032
  • Fax: 937-278-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03131697
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: