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NPI Code Detail

MEDICARE: POTTER'S HAND LLC

MEDICARE: POTTER'S HAND LLC
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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPH30348FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12167898OTHERPK

General Provider Information

NPI Number : 1598214702
Entity Type Code : Organization
Provider Name (Legal Business Name) : POTTER'S HAND LLC
Provider Business Mailing Address
First Line : 2180 E COUNTY ROAD 540A
Second Line :
City : LAKELAND
State : FL
Zip : 33813-3740
Country : US
Telephone Number : 863-937-5424
Fax Number : 863-937-5536
Provider Business Practice Location Address
First Line : 2180 E COUNTY ROAD 540A
Second Line :
City : LAKELAND
State : FL
Zip : 33813-3740
Country : US
Telephone Number : 863-937-5424
Fax Number : 863-937-5536
Authorized Official
Title or Position : PHARMACY MANAGER
Name : ANDREW ACHEAMPONG
Credential :
Telephone Number : 863-937-5424
Provider Enumeration Date : 09/28/2016
Last Update Date : 09/22/2017

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Directions to “POTTER'S HAND LLC ” Practice Location

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