Provider Demographics
NPI:1225338833
Name:POTTS, TOM E (PHARMD,)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:E
Last Name:POTTS
Suffix:
Gender:M
Credentials:PHARMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 N COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862-1370
Mailing Address - Country:US
Mailing Address - Phone:541-938-3289
Mailing Address - Fax:541-938-5357
Practice Address - Street 1:455 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MILTON FREEWATER
Practice Address - State:OR
Practice Address - Zip Code:97862-1370
Practice Address - Country:US
Practice Address - Phone:541-938-3289
Practice Address - Fax:541-938-5357
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0009553183500000X
ORRPH00095531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist