Provider Demographics
NPI:1144801481
Name:POTOSKY, ELAINE (RPH)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:POTOSKY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 ANTIGONE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2484
Mailing Address - Country:US
Mailing Address - Phone:240-731-5692
Mailing Address - Fax:
Practice Address - Street 1:12103 DARNESTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2205
Practice Address - Country:US
Practice Address - Phone:301-337-6430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist