Provider Demographics
NPI:1275821209
Name:POTTS, BRYAN F (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:F
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 1:801 N 29TH ST
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0905
Mailing Address - Country:US
Mailing Address - Phone:406-657-4095
Mailing Address - Fax:406-657-3859
Practice Address - Street 1:801 N 29TH ST
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0905
Practice Address - Country:US
Practice Address - Phone:406-657-4095
Practice Address - Fax:406-657-3859
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist