=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275821209
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRYAN F POTTS PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2011
-----------------------------------------------------
Last Update Date | 07/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 N 29TH ST ATTN: PHARMACY
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-0905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-657-4095
-----------------------------------------------------
Fax | 406-657-3859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 N 29TH ST ATTN: PHARMACY
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-0905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-657-4095
-----------------------------------------------------
Fax | 406-657-3859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5700
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------