Provider Demographics
NPI:1396402350
Name:POTTER, BATRINA DALE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BATRINA
Middle Name:DALE
Last Name:POTTER
Suffix:
Gender:F
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:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:ELKHORN CITY
Mailing Address - State:KY
Mailing Address - Zip Code:41522-0066
Mailing Address - Country:US
Mailing Address - Phone:606-616-1919
Mailing Address - Fax:
Practice Address - Street 1:220 E ELKHORN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522-8558
Practice Address - Country:US
Practice Address - Phone:606-754-5076
Practice Address - Fax:606-754-5557
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist