Provider Demographics
NPI:1497359798
Name:POTTER, CHRISTA (RPH)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:POTTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4002
Mailing Address - Country:US
Mailing Address - Phone:781-844-9090
Mailing Address - Fax:
Practice Address - Street 1:4 BROADWAY RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4002
Practice Address - Country:US
Practice Address - Phone:781-844-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3119183500000X
MA23703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist