Provider Demographics
NPI:1164417739
Name:POTTS, PATTY JANELLE (DPH)
Entity Type:Individual
Prefix:DR
First Name:PATTY
Middle Name:JANELLE
Last Name:POTTS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3
Mailing Address - Street 2:BOX 178
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-9803
Mailing Address - Country:US
Mailing Address - Phone:405-238-3525
Mailing Address - Fax:
Practice Address - Street 1:500 WILLIAMS ST
Practice Address - Street 2:JACKS RX
Practice Address - City:MAYSVILLE
Practice Address - State:OK
Practice Address - Zip Code:73057-9547
Practice Address - Country:US
Practice Address - Phone:405-867-4427
Practice Address - Fax:405-867-5267
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist