Provider Demographics
NPI:1164074316
Name:POTTER, KRISTAL STEPHANY URENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAL
Middle Name:STEPHANY URENA
Last Name:POTTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:STEPHANY
Other - Last Name:URENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:632 NW 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9373
Mailing Address - Country:US
Mailing Address - Phone:954-479-0866
Mailing Address - Fax:
Practice Address - Street 1:18301 N MIAMI AVE # 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4564
Practice Address - Country:US
Practice Address - Phone:305-760-7486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist