Active NPI
Kenneth Gregory Popp II, RPH
- Pharmacist
- Poplar Bluff, MO
National Provider Identifier
1700416146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 044833
- Practice address
- 225 Physicians Park Ste 100
Poplar Bluff, MO 63901-3918 - Phone
- (573) 778-9238
- NPI assigned
- Jan 24, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 044833 | MO | Primary |
Addresses
Primary practice location
225 Physicians Park Ste 100
Poplar Bluff, MO 63901-3918
Mailing address
380 Golden LN
Poplar Bluff, MO 63901-9133
Phone (573) 286-1023
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 044833 | Other | MO | MISSOURI STATE BOARD OF PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579824000000",
"number": "1700416146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "380 GOLDEN LN",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639019133",
"telephone_number": "573-286-1023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 PHYSICIANS PARK STE 100",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013918",
"telephone_number": "573-778-9238"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POPP",
"first_name": "KENNETH",
"middle_name": "GREGORY",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-24",
"last_updated": "2020-01-24",
"certification_date": "2020-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "044833",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSOURI STATE BOARD OF PHARMACY",
"identifier": "044833",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.