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General NPI Number Information
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NPI Number | 1164417739
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Entity Type | Individual
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Provider Name | PATTY JANELLE POTTS DPH
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Gender | Female
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 WILLIAMS ST JACKS RX
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City | MAYSVILLE
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State | OK
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Zip | 73057-9547
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Country | US
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Telephone | 405-867-4427
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Fax | 405-867-5267
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Provider Business Mailing Address
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Address Line | RR 3 BOX 178
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City | PAULS VALLEY
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State | OK
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Zip | 73075-9803
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Country | US
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Telephone | 405-238-3525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11129
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License Number State | OK
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