MEDICARE: MS. TAMMY NIXON-POTTS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00011733	WA

General Provider Information

NPI Number	:	1285935288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY NIXON-POTTS RPH

Provider Business Mailing Address
First Line	:	1233 N LIBERTY LAKE RD
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7518
Country	:	US
Telephone Number	:	509-893-1202
Fax Number	:	509-893-7578

Provider Business Practice Location Address
First Line	:	1233 N LIBERTY LAKE RD
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-7518
Country	:	US
Telephone Number	:	509-893-1202
Fax Number	:	509-893-7578

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2010
Last Update Date	:	11/06/2010

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