Healthcare Provider Details

I. General information

NPI: 1275336364
Provider Name (Legal Business Name): NORA LINDSAY POTTER PHARMACY INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2560
US

IV. Provider business mailing address

16524 TIMBERLINE DR
STRONGSVILLE OH
44136-7343
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-1774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5351017451
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: