Provider Demographics
NPI:1033486634
Name:POTTS, TREVOR BLAKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:BLAKE
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 1:2313 SE CAPRICORN AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-1821
Mailing Address - Country:US
Mailing Address - Phone:785-817-1020
Mailing Address - Fax:
Practice Address - Street 1:1001 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1700
Practice Address - Country:US
Practice Address - Phone:785-272-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-27
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist