Healthcare Provider Details

I. General information

NPI: 1215009303
Provider Name (Legal Business Name): SHANNON M POTTS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N PINE ST RELIANTRX
SPOKANE WA
99202-5029
US

IV. Provider business mailing address

46245 YELLOWSTONE LN
TEMECULA CA
92592-3094
US

V. Phone/Fax

Practice location:
  • Phone: 509-343-3400
  • Fax:
Mailing address:
  • Phone: 509-280-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00016692
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: