Provider Demographics
NPI:1568746261
Name:POPWELL, MARK A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:POPWELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6126
Mailing Address - Country:US
Mailing Address - Phone:208-497-0156
Mailing Address - Fax:208-497-0068
Practice Address - Street 1:1248 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6126
Practice Address - Country:US
Practice Address - Phone:208-497-0156
Practice Address - Fax:208-497-0156
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16246183500000X
IDP6772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist