Provider Demographics
NPI:1104221472
Name:POTAK, CATHERINE J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:J
Last Name:POTAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SANDRA RD
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2514
Mailing Address - Country:US
Mailing Address - Phone:413-218-6090
Mailing Address - Fax:
Practice Address - Street 1:18 SANDRA RD
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2514
Practice Address - Country:US
Practice Address - Phone:413-218-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235120183500000X
NHNH3836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist