Healthcare Provider Details

I. General information

NPI: 1699002972
Provider Name (Legal Business Name): BETSY JO POTTEIGER PHARMD BCACP BCGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2009
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 S MCKENZIE ST
FOLEY AL
36535-3541
US

IV. Provider business mailing address

PO BOX 1752
GULF SHORES AL
36547-1752
US

V. Phone/Fax

Practice location:
  • Phone: 251-971-6258
  • Fax:
Mailing address:
  • Phone: 928-566-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberS015912
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRP037060L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number20246
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberS015912
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRP037060L
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number20246
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: