Provider Demographics
NPI:1770793481
Name:SOPO, DEBORAH ANN (RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:SOPO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9687 PEER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8121
Mailing Address - Country:US
Mailing Address - Phone:248-437-7452
Mailing Address - Fax:248-446-1305
Practice Address - Street 1:2050 N. LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-230-2276
Practice Address - Fax:810-720-2757
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist