Provider Demographics
NPI:1316356975
Name:POTTER, GEORGIANNA (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:
Last Name:POTTER
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 1:180 NIBLICK RD
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-4842
Mailing Address - Country:US
Mailing Address - Phone:805-238-2626
Mailing Address - Fax:805-238-2049
Practice Address - Street 1:180 NIBLICK RD
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-4842
Practice Address - Country:US
Practice Address - Phone:805-238-2626
Practice Address - Fax:805-238-2049
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist