Healthcare Provider Details

I. General information

NPI: 1396402350
Provider Name (Legal Business Name): BATRINA DALE POTTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E ELKHORN ST
ELKHORN CITY KY
41522-8558
US

IV. Provider business mailing address

PO BOX 66
ELKHORN CITY KY
41522-0066
US

V. Phone/Fax

Practice location:
  • Phone: 606-754-5076
  • Fax: 606-754-5557
Mailing address:
  • Phone: 606-616-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022468
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: