MEDICARE: ROHINI D POTLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5315152473	MI

General Provider Information

NPI Number	:	1265125181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROHINI D POTLA

Provider Business Mailing Address
First Line	:	29919 STANHURST RD
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1934
Country	:	US
Telephone Number	:	248-320-7909
Fax Number	:

Provider Business Practice Location Address
First Line	:	27241 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-3406
Country	:	US
Telephone Number	:	248-331-1112
Fax Number	:	248-331-1114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	05/26/2023

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Directions to “ ROHINI D POTLA ” Practice Location

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