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NPI Code Detail

MEDICARE: MATTHEW H POTTER

MEDICARE: MATTHEW H POTTER
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
1183500000XPharmacist72827CA

General Provider Information

NPI Number : 1548800378
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW H POTTER
Provider Business Mailing Address
First Line : 3746 ALABAMA ST APT 203
Second Line :
City : SAN DIEGO
State : CA
Zip : 92104-5917
Country : US
Telephone Number : 740-803-1887
Fax Number :
Provider Business Practice Location Address
First Line : 7100 BROADWAY
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-1401
Country : US
Telephone Number : 619-697-3415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2020
Last Update Date : 01/09/2020

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