MEDICARE: JONATHAN POTTER

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0020431	CO
2	183500000X	Pharmacist	0020431	CO

General Provider Information

NPI Number	:	1891196150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN POTTER

Provider Business Mailing Address
First Line	:	2600 N 12TH ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-8190
Country	:	US
Telephone Number	:	970-628-7574
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 N 12TH ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-8190
Country	:	US
Telephone Number	:	970-628-7574
Fax Number	:

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

Provider Enumeration Date	:	09/05/2014
Last Update Date	:	06/18/2026

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