Healthcare Provider Details

I. General information

NPI: 1518728195
Provider Name (Legal Business Name): GREAT POTTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82013 DR CARREON BLVD STE I
INDIO CA
92201-5832
US

IV. Provider business mailing address

35782 RAPHAEL DR
PALM DESERT CA
92211-4506
US

V. Phone/Fax

Practice location:
  • Phone: 442-215-5785
  • Fax: 442-215-5870
Mailing address:
  • Phone: 760-880-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JACKY KAMEL
Title or Position: CEO
Credential: RPH
Phone: 760-880-7546