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General NPI Number Information
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NPI Number | 1548869688
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Entity Type | Individual
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Provider Name | JEFFERY TAYLOR POTTER II PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 2308 HIGHWAY 144
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City | OWENSBORO
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State | KY
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Zip | 42303-0175
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Country | US
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Telephone | 270-926-7751
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 SAINT ANN ST
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City | OWENSBORO
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State | KY
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Zip | 42303-7059
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Country | US
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Telephone | 270-922-0395
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 051302286
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 020210
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License Number State | KY
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